Menopausal shift on women’s health and microbial niches Original paper

What was reviewed?

This narrative review comprehensively examines how the menopausal transition in women, marked by a decline in estrogen and other sex hormones, leads to profound changes in the microbiome across key body sites: oral, intestinal (gut), and urogenital (vaginal and urinary). The review reveals the bidirectional interplay between hormonal shifts and the microbiome, illustrating how menopause-induced hormonal changes alter the composition, richness, and function of microbial communities. Key topics include the impact of estrogen and progesterone fluctuations on microbial diversity, the concept of the “menopause paradox” (where dominance of protective microbes decreases while overall diversity increases), and the role of the microbiome in mediating disease risk and symptomatology during menopause. The review further discusses the microbial metabolism of sex hormones, highlighting how certain microbes can influence hormone availability and, in turn, host physiology and health outcomes.

Who was reviewed?

The reviewed literature encompasses studies of women across the menopausal transition, including premenopausal, perimenopausal, and postmenopausal women, with particular focus on changes in oral, gut, and vaginal microbial communities. The review references diverse cohorts and methodologies, with most primary data derived from studies of women aged 40–59 (the typical age range for menopause). However, the authors note a significant overrepresentation of Western populations in existing research, with limited inclusion of non-Western, African, Asian, or Latin American cohorts, which may affect global generalizability of findings. The review also considers relevant animal models and in vitro studies that inform understanding of hormone-microbe interactions.

Most important findings

The review highlights that menopause is associated with a marked reduction in estrogen and progesterone, which drives systemic changes in multiple mucosal tissues and their resident microbiota. In the oral cavity, menopause can lead to decreased salivary flow and pH, increased risk of periodontal disease, and shifts in microbial composition, such as increased Prevotella copri and reduced Veillonella tobetsuensis. Periodontal pathogens like Porphyromonas gingivalis and Tannerella forsythia become more prominent, while certain commensals (e.g., Bifidobacterium dentium) may offer protective effects. Fungal dysbiosis, particularly candidiasis, is also more common. In the gut, menopause is linked to reduced microbial diversity and altered abundance of taxa, including increased Bacteroides, Prevotella, Veillonella, and Sutterella, and decreased Ruminococcus (a beneficial butyrate-producer). The gut microbiome’s ability to metabolize estrogens (the “estrobolome”) becomes especially relevant, influencing circulating hormone levels and potentially affecting cardiovascular, metabolic, and autoimmune risk.

The vaginal microbiome undergoes the “menopause paradox”: a decrease in Lactobacillus dominance and a rise in overall microbial richness, favoring colonization by anaerobic taxa such as Prevotella, Gardnerella, and Atopobium. This microbial shift is associated with increased vaginal pH, atrophy, dryness, and susceptibility to infections (bacterial vaginosis, candidiasis) and may contribute to higher risk of malignancy and urogenital symptoms. The review also describes the capacity of some oral and gut microbes to metabolize sex steroids, thus influencing systemic hormone availability and potentially modulating menopause-related symptoms.

Key implications

For clinicians, this review underscores the importance of considering the menopause-induced microbiome shift as a significant factor in women’s health, beyond hormonal changes alone. The interplay between declining estrogen/progesterone and microbial community structure increases the risk for oral disease, gut dysbiosis, and urogenital infections. Microbial signatures such as reduced Lactobacillus in the vagina or increased periodontal pathogens could inform risk stratification, early detection, and the development of targeted interventions. Personalized therapies incorporating diet, probiotics, hormone replacement, or microbiome-targeted interventions may help restore microbial balance, alleviate symptoms, and reduce disease risk in menopausal women. Importantly, the review calls for more geographically and ethnically diverse research to ensure findings are globally applicable.