Alterations in vaginal and urinary microbiota in menopause and associated pathologies: A narrative review

Background: In the premenopausal stage, the vaginal microbiota is characterized by a high abundance of Lactobacillus, a key genus for preserving a healthy vaginal environment. However, the estrogen decline associated with menopause modifies this microbial community, leading to a reduction in Lactobacillus and promoting the proliferation of anaerobic bacteria, thereby increasing the risk of dysbiosis, as observed in bacterial vaginosis. Likewise, the urinary microbiota undergoes alterations that heighten the susceptibility of postmenopausal women to urinary tract infections. Hormonal changes also cause symptoms such as vaginal dryness, irritation, and dyspareunia, resulting from urogenital atrophy, which affects not only physical health but also emotional well-being and quality of life. Aim: The aim of the study was to describe the changes of the vaginal and urinary microbiota’s associated with estrogen deficiency in menopause, as well as their relationship with relevant clinical conditions, including pelvic floor diseases, genital infections, periodontal disease, and gynecological cancers. Relevance for patients: Understanding these microbial changes is crucial for optimizing clinical management and improving the overall health of women in this stage of life, as these alterations represent an emerging field of research with important diagnostic and therapeutic implications.