Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA.
J Gerontol A Biol Sci Med Sci. 2021 Aug 13;76(9):1542-1550. doi: 10.1093/gerona/glab120.
The genitourinary syndrome of menopause (GSM) describes signs and symptoms resulting from effects of estrogen deficiency on the female genitourinary tract, including the vagina, labia, urethra, and bladder. Signs/symptoms associated with GSM may occur during any reproductive stage from multiple etiologies but are most common during menopause due to low estrogen. Vaginal microbiota, particularly Lactobacillus spp., are beneficial to the female genital tract; however, their abundance declines during menopause. We aimed to longitudinally assess vaginal microbiota characterized by 16S rRNA gene amplicon sequencing and GSM-associated endpoints across reproductive stages. In a 2-year cohort study of 750 women aged 35-60 years at enrollment and 2 111 semiannual person-visits, low-Lactobacillus vaginal microbiota communities were observed at 21.2% (169/798), 22.9% (137/597), and 49.7% (356/716) of person-visits among pre-, peri-, and postmenopausal women, respectively (p < .001). Compared to communities that have high Gardnerella vaginalis relative abundance and diverse anaerobes, the following communities were associated with a lower covariate-adjusted odds of vaginal atrophy: L crispatus-dominated communities among postmenopausal women (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.08, 0.81), L gasseri/L jensenii (OR = 0.21; 95% CI: 0.05, 0.94) and L iners (OR = 0.21; 95% CI: 0.05, 0.85) among perimenopausal women, and L iners-dominated communities (OR = 0.18; 95% CI: 0.04, 0.76) among premenopausal women. Postmenopausal women with L gasseri/L jensenii-dominated communities had the lowest odds of vaginal dryness (OR = 0.36; 95% CI: 0.12, 1.06) and low libido (OR = 0.28; 95% CI: 0.10, 0.74). Findings for urinary incontinence were inconsistent. Associations of vaginal microbiota with GSM signs/symptoms are most evident after menopause, suggesting an avenue for treatment and prevention.
女性生殖泌尿系统绝经期综合征（GSM）描述了雌激素缺乏对女性生殖泌尿系统（包括阴道、阴唇、尿道和膀胱）产生影响而导致的体征和症状。GSM 相关的体征/症状可能发生在多种病因的任何生殖阶段，但由于雌激素水平低，最常见于绝经期。阴道微生物群，特别是乳杆菌属，对女性生殖道有益；然而，它们的丰度在绝经期下降。我们旨在通过 16S rRNA 基因扩增子测序和跨生殖阶段评估与 GSM 相关的终点，对阴道微生物群进行纵向评估。在一项对 750 名年龄在 35-60 岁的女性进行的为期 2 年的队列研究中，在绝经前、绝经中和绝经后女性的 2111 次半年度人次访视中，分别有 21.2%（169/798）、22.9%（137/597）和 49.7%（356/716）的人次访视存在低乳杆菌阴道微生物群社区（p<0.001）。与具有高加德纳菌相对丰度和多样化厌氧菌的社区相比，以下社区与阴道萎缩的调整后比值比（OR）较低相关：绝经后女性中 L crispatus 主导的社区（OR=0.25；95%置信区间[CI]：0.08，0.81）、绝经前女性中 L gasseri/L jensenii（OR=0.21；95%CI：0.05，0.94）和 L iners（OR=0.21；95%CI：0.05，0.85）以及 L iners 主导的社区（OR=0.18；95%CI：0.04，0.76）。L gasseri/L jensenii 主导的社区绝经后女性发生阴道干燥（OR=0.36；95%CI：0.12，1.06）和性欲低下（OR=0.28；95%CI：0.10，0.74）的可能性最低。尿失禁的相关性不一致。阴道微生物群与 GSM 体征/症状的关联在绝经后最为明显，这为治疗和预防提供了一种途径。
