Institute of Biomedical Big Data, School of Ophthalmology & Optometry and Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China.
Menopause. 2024 Nov 1;31(11):1014-1023. doi: 10.1097/GME.0000000000002432. Epub 2024 Sep 3.
To compare the vaginal microbiota of premenopausal and postmenopausal women and postmenopausal women undergoing menopausal hormone therapy (MHT) and examine the association between vaginal microbiota and genitourinary syndrome of menopause (GSM).
This cross-sectional study classified 94 women aged 40 to 60 years into three groups: premenopausal (Pre, n = 32), postmenopausal (Post, n = 30), and postmenopausal women who received MHT orally (Post + MHT, n = 32). Neither the Pre nor the Post group received hormone therapy within the past 6 months. Postmenopausal women who received vaginal MHT were not included. Vaginal swabs were obtained, and microbial composition was characterized by 16S rRNA gene sequencing targeting the V3 to V4 region. Clinical data were collected and serum sex hormones were measured. The most bothersome symptom approach and vaginal health index were used to evaluate GSM. Mann-Whitney U or Kruskal-Wallis ANOVA followed by multiple comparison tests were performed for comparison between or across groups. The correlations between GSM symptom scores and vaginal microbiota were determined using Spearman's correlation analysis.
The vaginal community of postmenopausal women was characterized by a decreased abundance of Lactobacillus (Post 18% vs Pre 69%); an increased abundance of several anaerobic bacteria, including Prevotella , Escherichia-Shigella , and Bifidobacterium ; and a higher microbial diversity ( P < 0.001 for Shannon and Simpson indexes) than those of premenopausal women. The vaginal community of postmenopausal women who received MHT had an increased abundance of Lactobacillus (54%) and lower microbial diversity ( P < 0.001 for Shannon and Simpson indexes) than the postmenopausal women. The vaginal microbial community composition of the Pre group shared more similarity with that of the Post + MHT group (Adonis P = 0.051) than with that of the Post group (Adonis P < 0.001). A decreased abundance of Lactobacillus and high diversity in the vaginal community were found in women with moderate to severe GSM symptoms.
Among Chinese postmenopausal women, those receiving MHT had higher Lactobacillus abundance but lower abundance of diverse anaerobes and diversity of the vaginal microbial community compared to non-MHT women. MHT in postmenopausal women may potentially contribute to reestablishing vaginal microbiota homeostasis. Findings in this pilot study, however, need to be examined in larger, prospective studies.
比较绝经前、绝经后及接受绝经后激素治疗（MHT）的绝经后女性的阴道微生物群，并探讨阴道微生物群与绝经后女性生殖泌尿系统综合征（GSM）的关系。
本横断面研究将 94 名年龄在 40 至 60 岁的女性分为三组：绝经前（Pre，n=32）、绝经后（Post，n=30）和口服接受 MHT 的绝经后女性（Post+MHT，n=32）。Pre 组和 Post 组均在过去 6 个月内未接受激素治疗。未纳入接受阴道 MHT 的绝经后女性。采集阴道拭子，采用 16S rRNA 基因测序技术对 V3 到 V4 区进行微生物组成特征分析。收集临床资料并测量血清性激素。采用最困扰症状方法和阴道健康指数评估 GSM。采用 Mann-Whitney U 或 Kruskal-Wallis ANOVA 检验进行组间比较，采用多重比较检验进行两两比较。采用 Spearman 相关分析确定 GSM 症状评分与阴道微生物群之间的相关性。
绝经后女性的阴道菌群特征为乳杆菌丰度降低（Post 为 18%，Pre 为 69%）；几种厌氧菌丰度增加，包括普雷沃氏菌属、埃希氏-志贺氏菌属和双歧杆菌属；微生物多样性较高（Shannon 和 Simpson 指数 P<0.001）。接受 MHT 的绝经后女性的阴道菌群中乳杆菌丰度增加（54%），微生物多样性降低（Shannon 和 Simpson 指数 P<0.001）。Pre 组的阴道微生物群组成与 Post+MHT 组（Adonis P=0.051）的相似性高于与 Post 组（Adonis P<0.001）。中度至重度 GSM 症状女性阴道菌群中乳杆菌丰度降低，多样性较高。
在中国绝经后女性中，与未接受 MHT 的女性相比，接受 MHT 的女性阴道乳杆菌丰度较高，但多样性较低的厌氧菌丰度和阴道微生物群多样性较低。MHT 可能有助于绝经后女性重建阴道微生物群稳态。然而，本研究结果需要在更大的前瞻性研究中进一步验证。
