Microbes are a key marker of vaginal health during menopause

Certain species of bacteria are actually necessary to maintain vaginal health. The menopause transition, however, often upsets the natural balance of bacteria by decreasing the proportion of healthy bacteria and increasing vaginal pH. This can result in urogenital infections and other vaginal health problems. The importance of vaginal bacterial colonization patterns during menopause will be discussed at The North American Menopause Society (NAMS) Annual Meeting in Chicago, September 25-28, 2019.

The community of microbes colonizing the vagina has a profound impact on reproductive and sexual health. The bacterial genus Lactobacillus dominates in healthy vaginas, protecting women from urogenital infections by maintaining a low pH level of less than 4.5. They are also associated with a lower risk for HIV acquisition, bacterial sexually transmitted infections, and persistent HPV infection in premenopausal women.

After menopause, however, the proportion of lactobacilli typically decrease in the vagina, making women more vulnerable to genital infections, urinary tract infections, and cervical dysplasia. To date, few studies have focused on this association in postmenopausal women, so it has yet to be proven whether the decolonization of healthy bacteria also causes common postmenopausal vaginal discomfort.

Currently, the most reliable strategy for promoting vaginal Lactobacillus colonization after menopause is treatment with estrogen. However, additional therapies are in development, including oral and vaginal probiotics. These strategies, along with a discussion regarding changes in vaginal microbes during menopause, will be addressed at the upcoming NAMS Annual Meeting by Dr. Caroline Mitchell from Harvard Medical School and Massachusetts General Hospital.

"It is important that women and their healthcare providers understand the important role played by bacteria in the vagina and the limitations of current strategies for modulating the vaginal microbiota after menopause, due to a lack of robust data," says Dr. Mitchell. "Women deserve correct information about what we do and don't know."

"With so many postmenopausal women affected by vulvovaginal atrophy, vaginal dryness, and a related decrease in their overall quality of life, this topic is expected to have widespread appeal and the presentation will likely educate healthcare providers on the latest treatment options," says Dr. Stephanie Faubion, NAMS medical director.