Connecting microbiome and menopause for healthy ageing Original paper

What was reviewed?

This comprehensive review article explores the interplay between the gut and vaginal microbiome and menopause, focusing on implications for healthy aging in women. The authors synthesize recent research, highlighting how hormonal changes during menopause reshape the vaginal ecosystem, particularly through the decline of Lactobacillus dominance and increased prevalence of anaerobes and pathobionts. The review examines clinical and mechanistic studies addressing the association between microbial shifts and menopausal symptoms, such as genitourinary syndrome of menopause (GSM), recurrent urinary tract infections (UTIs), and vasomotor and neuropsychiatric symptoms. The authors also discuss the potential for microbiome-targeting interventions, including hormone replacement, probiotics, and emerging interventions like vaginal microbiota transplantation, summarizing evidence for their safety, efficacy, and effects on the vaginal microbiota during and after menopause.

Who was reviewed?

The review encompasses research conducted predominantly on peri- and postmenopausal women, with most clinical studies involving primarily Caucasian populations. The included studies span a range of sample sizes, from small longitudinal cohorts to larger randomized controlled trials, as well as cross-sectional analyses. The authors note a significant gap in research involving women of diverse racial, ethnic, and socioeconomic backgrounds, despite evidence that these factors influence microbiome composition. The reviewed literature also references women receiving various menopausal therapies (e.g., hormone replacement, DHEA, ospemifene) and those experiencing surgical or therapy-induced menopause (e.g., after oophorectomy or aromatase inhibitor use).

Most important findings

A key finding is the strong correlation between declining estrogen levels during menopause and a shift from a Lactobacillus-dominated vaginal microbiome to one characterized by increased diversity, including anaerobes (Gardnerella, Prevotella, Anaerococcus, Peptoniphilus, Peptostreptococcus) and pathobionts (Escherichia, Enterococcus, Streptococcus, Corynebacterium, Staphylococcus). This microbial shift is linked to elevated vaginal pH, atrophic changes, and increased susceptibility to GSM and UTIs. While some studies show that Lactobacillus depletion correlates with more severe genitourinary symptoms, others find no such association, underscoring the need for further research. Therapeutic interventions, such as local estrogen therapy, DHEA, and ospemifene, generally restore Lactobacillus dominance and lower vaginal pH, improving symptoms. Probiotics and live biotherapeutics show promise but lack robust data in postmenopausal women. Emerging concepts like precision probiotics and vaginal microbiota transplantation represent future avenues for tailored microbiome restoration.

Key implications

The review underscores the clinical relevance of the microbiome in menopausal health, advocating for more inclusive, mechanistic, and longitudinal research to clarify microbial contributions to symptoms and treatment responses. Restoration of Lactobacillus dominance in the vaginal niche—via hormone therapy, novel probiotics, or microbiota transplantation—may directly impact genitourinary and systemic health in menopausal women. The authors call for precision approaches and greater representation of diverse populations in future studies. Ultimately, microbiome-informed interventions could improve quality of life, reduce adverse health outcomes post-menopause, and move toward personalized medicine in women’s health.