TY - JOUR
T1 - Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy
AU - Brotman, Rebecca M.
AU - Shardell, Michelle D.
AU - Gajer, Pawel
AU - Fadrosh, Doug
AU - Chang, Kathryn
AU - Silver, Michelle I.
AU - Viscidi, Raphael P.
AU - Burke, Anne E.
AU - Ravel, Jacques
AU - Gravitt, Patti E.
N1 - Funding Information:
Funding/support: This study was supported by National Institutes of Health grants K01-AI080974 (R.M.B.), K25-AG034216 (M.D.S.), U01-AI070921 (J.R.), UH2-AI083264 (J.R.), and R01-CA123467 (P.E.G.).
Publisher Copyright:
© 2013 by The North American Menopause Society.
PY - 2018
Y1 - 2018
N2 - Objective: The vaginal microbiota helps protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA). Methods: Eighty-seven women (aged 35-60 y) were classified as premenopausal (n=30), perimenopausal (n=29), or postmenopausal (n=28) according to Stages of Reproductive Aging Workshop guidelines. Midvaginal bacterial community composition was characterized by 16S ribosomal RNA gene analysis. Results: Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii, and two (CST IV-A and CST IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B was characterized by Atopobium. There were significant associations between menopause stage and CST (P=0.004) and between VVA and CST (P=0.002). Perimenopausal women were more likely to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were often classified as CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared with women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A versus L. crispatus CST (adjusted odds ratio, 25.89; 95% credible interval, 2.98-406.79). Conclusions: A distinct bacterial community state (CST IV-A) with a low relative abundance of Lactobacillus is associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate, and restore vaginal microbiota homeostasis, which would provide stronger evidence for a causal relationship with VVA and ultimately improve the treatment and prevention of atrophic vaginitis in menopause.
AB - Objective: The vaginal microbiota helps protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA). Methods: Eighty-seven women (aged 35-60 y) were classified as premenopausal (n=30), perimenopausal (n=29), or postmenopausal (n=28) according to Stages of Reproductive Aging Workshop guidelines. Midvaginal bacterial community composition was characterized by 16S ribosomal RNA gene analysis. Results: Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii, and two (CST IV-A and CST IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B was characterized by Atopobium. There were significant associations between menopause stage and CST (P=0.004) and between VVA and CST (P=0.002). Perimenopausal women were more likely to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were often classified as CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared with women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A versus L. crispatus CST (adjusted odds ratio, 25.89; 95% credible interval, 2.98-406.79). Conclusions: A distinct bacterial community state (CST IV-A) with a low relative abundance of Lactobacillus is associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate, and restore vaginal microbiota homeostasis, which would provide stronger evidence for a causal relationship with VVA and ultimately improve the treatment and prevention of atrophic vaginitis in menopause.
KW - 16S ribosomal RNA gene analysis
KW - Menopause
KW - Vaginal atrophy
KW - Vaginal microbiota
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U2 - 10.1097/gme.0b013e3182a4690b
DO - 10.1097/gme.0b013e3182a4690b
M3 - Article
C2 - 30358729
AN - SCOPUS:85055608137
SN - 1072-3714
VL - 25
SP - 1321
EP - 1330
JO - Menopause
JF - Menopause
IS - 11
ER -