The Menopausal Microbiome: Understanding Hormonal Shifts and Vaginal Health

Menopause represents a significant hormonal shift, and its impact on the vaginal and vulvar microbiomes remains an area of emerging research. Given the prevalence of menopause-related conditions, understanding these changes is critical for advancing women's health and the treatment thereof.

What We Know:

Menopause introduces systemic symptoms and distinct changes in the vaginal microbiome, primarily driven by reduced estrogen levels. This reduction often leads to a decline in the dominant and favourable Lactobacillus species, increasing the risk of microbial dysbiosis which is associated with further health complications including bacterial vaginosis, aerobic vaginitis, vulvovaginal candidiasis and increased risk of sexually transmitted infections (Muhleisen & Herbst-Kralovetz, 2016).

Estrogen plays a vital role in regulating the vaginal microbiological environment by maintaining epithelial thickness and glycogen levels, promoting mucus secretion and lowering vaginal pH via Lactobacilli colonisation and lactic acid production (Barrea et al., 2023).

These changes, along with shifts in the gut and oral microbiomes during menopause, are hypothesised to contribute to the development of menopause-related diseases, including osteoporosis, breast cancer, endometrial hyperplasia, periodontitis and cardiometabolic disorders. Therefore, interventions and solutions are crucial (Barrea et al., 2023).

Industry Impact and Potential:

Hormone replacement therapy (HRT) has been shown to enhance Lactobacillus dominance in the vaginal microbiome, alleviating symptoms of dysbiosis. However, the negative side effects of HRT experienced by some patients mean that alternatives to this are necessary (Muhleisen & Herbst-Kralovetz, 2016).

Oral and vaginal probiotics hold great promise. Initial studies complement previous research findings on the menopause-vaginal microbiome connection, but additional trials are needed to determine the efficacy of bacterial therapeutics to modulate or restore vaginal homeostasis (Muhleisen & Herbst-Kralovetz, 2016).

In one study, a two-week oral supplementation with four Lactobacillus species (two capsules daily) positively influenced vaginal microbiota colonisation in 22 postmenopausal patients undergoing chemotherapy for breast cancer. Although this is a small sample size, it highlights the potential of probiotic treatments (Marschalek et al., 2017).

Our Solution:

In addition to vulvar microbiome analysis, we at Sequential provide services for assessing skin, scalp and oral microbiomes. We have established our company as a leader in facilitating the assessment and development of products that maintain microbiome integrity. Our team of experts is well-equipped to support your company in formulating innovative products and studies aimed at maintaining and improving the vulvar microbiome to support women’s health.

References:

Barrea, L., Verde, L., Auriemma, R.S., Vetrani, C., Cataldi, M., Frias-Toral, E., Pugliese, G., Camajani, E., Savastano, S., Colao, A. & Muscogiuri, G. (2023) Probiotics and Prebiotics: Any Role in Menopause-Related Diseases? Current Nutrition Reports. 12 (1), 83–97. doi:10.1007/s13668-023-00462-3.

Marschalek, J., Farr, A., Marschalek, M.-L., Domig, K.J., Kneifel, W., Singer, C.F., Kiss, H. & Petricevic, L. (2017) Influence of Orally Administered Probiotic Lactobacillus Strains on Vaginal Microbiota in Women with Breast Cancer during Chemotherapy: A Randomized Placebo-Controlled Double-Blinded Pilot Study. Breast Care (Basel, Switzerland). 12 (5), 335–339. doi:10.1159/000478994.

Muhleisen, A.L. & Herbst-Kralovetz, M.M. (2016) Menopause and the vaginal microbiome. Maturitas. 91, 42–50. doi:10.1016/j.maturitas.2016.05.015.