Health disorders in menopausal women: microbiome alterations, associated problems, and possible treatments Original paper

What was reviewed?

This comprehensive review systematically examines the multifaceted health disorders associated with menopause, focusing on microbiome alterations and their implications across various body sites, including the vaginal, gut, urethral, oral, and duodenal microbiomes. It explores the interplay between declining estrogen levels during menopause and disruptions in microbial communities, the consequent impact on disease risks, ranging from reproductive disorders, metabolic syndrome, cardiovascular diseases, bone health, mental health, and other systemic conditions, and discusses current and emerging interventions including dietary modifications, hormone therapy, probiotics, plant extracts, and traditional therapies.

Who was reviewed?

The review synthesizes findings from a wide range of human observational and interventional studies involving peri- and postmenopausal women, alongside relevant animal models and mechanistic research. It includes clinical and molecular studies examining microbiome compositional changes, microbial metabolic functions, immune modulation, and symptom relief strategies. It also incorporates data on socioeconomic and lifestyle factors influencing menopausal health outcomes.

Most important findings

Menopause triggers a decline in estrogen that profoundly alters microbial communities, particularly the depletion of Lactobacillus in the vaginal and urethral microbiomes, increasing susceptibility to infections and genitourinary syndrome of menopause (GSM). Gut microbiota diversity decreases with shifts in Firmicutes/Bacteroidetes ratios, leading to reduced production of beneficial metabolites like short-chain fatty acids, impairing intestinal barrier integrity and immune regulation. Duodenal microbiome alterations, such as increased Proteobacteria and decreased Bacteroidetes, associate with elevated cardiovascular risk, influenced further by hormone therapy. Oral microbiota imbalances increase periodontal disease risk, while microbial dysbiosis broadly correlates with metabolic disorders like obesity and type 2 diabetes, osteoporosis, and mental health disturbances. Interventions including dietary fiber, soy isoflavones, probiotic supplementation, menopausal hormone therapy (MHT), and plant extracts (black cohosh, red clover, soybean) show promise in modulating these microbiomes, improving symptoms, and reducing disease risks.

Key implications

This review highlights the critical role of microbiome dysbiosis in menopause-associated health disorders and supports integrative intervention strategies that target microbial balance alongside hormonal and lifestyle factors. It advocates for personalized medicine approaches combining diet, probiotics, hormone therapy, and traditional treatments to optimize menopausal health. Future research should prioritize mechanistic studies, synergistic interventions, and psychosocial factors to enhance disease prevention, diagnosis, and management in menopausal women.