Abstract
For decades hormone therapy (HT) has been prescribed to treat the symptoms of menopause, such as vaginal dryness, itching and burning. Here we sought to compare the vaginal microbiomes of postmenopausal women who received low dose estrogen therapy to those of premenopausal and postmenopausal women, and to do so in conjunction with assessing the alleviation of symptoms associated with vaginal atrophy. In this study vaginal swab samples were obtained from 45 women who were classified as either premenopausal, postmenopausal, or postmenopausal and undergoing HT. The vaginal microbiomes of these women were characterized by 16S rRNA gene sequencing and bacterial abundances were quantified by qPCR. We found that the vaginal communities from our cohort could be divided into six clusters (A-F) based on differences in the composition and relative abundances of bacterial taxa. Communities in cluster A were dominated by Lactobacillus crispatus, and those of cluster B were dominated by Gardnerella vaginalis. Communities in cluster C had high proportions of L. iners, while those in cluster D were more even and included several co-dominant taxa. Communities in clusters E and F were dominated by Bifidobacterium and L. gasseri, respectively. The vaginal communities of most postmenopausal women receiving HT (10/15) were dominated by species of lactobacilli and belonged to clusters A, C, and F (P < 0.001). This sharply contrasts with vaginal communities of postmenopausal women without HT, most of which (10/15) were in cluster D, depleted of lactobacilli, and had about 10-fold fewer total bacteria (P < 0.05). The vaginal communities of women in each study group differed in terms of the dominant bacterial species composition and relative abundance. Those of postmenopausal women receiving HT significantly differed from those of postmenopausal women without HT and were most often dominated by species of Lactobacillus. Noteworthy, HT greatly improved vaginal atrophy scores, decreased vaginal pH, and significantly increased bacterial numbers in comparison to postmenopausal women not receiving HT.
Highlights
Menopause usually occurs in the fourth or fifth decade of life and is defined as cessation of menstruation for 12 consecutive months marking the end of fertility
Of the women enrolled in the study (Supplementary Table S1), one group included only premenopausal women (PRE), mean age of 33 (±6.4) years, with a vaginal pH ≤ 5 and vaginal atrophy score ≤2
The mean age of postmenopausal women enrolled in the study was 60.5 years, and height, weight and BMI were comparable among the groups
Summary
Menopause usually occurs in the fourth or fifth decade of life and is defined as cessation of menstruation for 12 consecutive months marking the end of fertility. Changes in the vaginal environment during menopause are accompanied by changes in the species composition of the vaginal microbiome (Hillier and Lau, 1997; Brotman et al, 2014; Shen et al, 2016) Often this is manifest in decreased proportions of lactobacilli and lactic acid production, causing an increased vaginal pH that possibly renders the vagina more susceptible to infections and exacerbates the vaginal symptoms associated with VVA. Findings show that the communities of women who receive HT often resemble those of premenopausal women by essentially restoring high proportions of Lactobacillus, but the means by which this occurs is not understood (Mitchell et al, 2017) In this cross-sectional pilot study, we explicitly compared the vaginal microbiomes of premenopausal women to those of postmenopausal women who receive various forms of HT and those that do not. We determined bacterial abundance, estimated the species richness and evenness of vaginal communities, and measured various biomarkers of inflammation in the vulvovaginal area
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