Lactobacilli still beneficial after menopause
After menopause, Lactobacillus dominance and low alpha diversity are associated with less vaginal inflammation, as previously reported in pre-menopausal women. Thus, despite their reduced presence, Lactobacilli seem to continue to have beneficial effects.
Lay public section
Find here your dedicated section
About this article
We know that in pre-menopausal women, increased diversity in the vaginal microbiota and a loss of Lactobacillus dominance are associated with greater mucosal inflammation. This leads to a higher risk of dysplasia and cervical infection.
Does this link between vaginal microbiota and inflammation continue after menopause? The post-menopausal period remains poorly understood, even if we know that the vaginal microbiota tends to become more diversified and less dominated by lactobacilli once the reproductive period is over.
A US study 1 on 119 post-menopausal women (average age 61 at inclusion) seeking treatment for moderate to severe vulvovaginal discomfort (irritation, dryness, etc.) sought to answer this question.
119 post-menopausal women
The subjects were divided into three groups based on the treatment received and were followed for twelve weeks. The three treatments were as follows:
- estradiol tablet and placebo moisturizing gel
- placebo tablet and moisturizing gel
- double placebo
At baseline, 29.5% of participants had their vaginal microbiota dominated by lactobacilli.
Caucasian women were less likely to have this protective flora. Overall, lower Lactobacillus dominance and lower alpha diversity in vaginal fluids were associated with lower concentrations of inflammatory immune markers, while complete loss of Lactobacillus dominance was associated with higher concentrations of pro-inflammatory (sidenote: Cytokine A small protein involved in communication between cells, especially in the immune system. Cytokines: Introduction_British Society for Immunology ) , as observed in previous studies on post-menopausal women.
21 years Globally, a woman aged 60 years in 2019 could expect to live on average another 21 years.
26% The global population of post-menopausal women is growing. In 2021, women aged 50 and over accounted for 26% of all women and girls globally. This was up from 22% 10 years earlier.
Lasting support from lactobacilli
This mirrors the tendency reported in women of childbearing age. Lactobacilli may thus continue to play a protective role after menopause, with beneficial effects on the immunity of the vaginal mucosa by helping to reduce inflammation – or at the very least, by being associated with this decrease.
Conversely, an increase in the alpha diversity of the vaginal microbiota is thought to be associated with pro-inflammatory cytokines.
These results imply that low diversity and high lactobacilli dominance remain beneficial to vaginal health. While Lactobacillus dominance may not be “normal” after menopause, it could represent a favorable microenvironment associated with a lower inflammatory status.
