Estradiol-associated shifts in vaginal microbiota: Insights from menopausal and reproductive women

Abstract

Introduction: Estradiol plays a key role in maintaining vaginal microbial balance, particularly by supporting Lactobacillus dominance.Hormonal shifts during menopause may disrupt this balance, increasing susceptibility to dysbiosis and related symptoms.Aim and Objective: This study aims to analyze the correlation between estradiol levels and vaginal microbiota patterns in menopausal and reproductive women. Materials and Methods:This cross-sectional study involved 59 women (29 menopausal and 30 reproductive-aged).Blood samples were collected to measure serum estradiol using ELISA, and vaginal swabs were analyzed via 16S rRNA gene sequencing.Correlations between estradiol levels and microbiota patterns were assessed using IBM SPSS Statistics Version 30.0.0.0.Result: Menopausal women showed significantly lower estradiol levels (4.0 vs 100.84 ng/mL, p<0.001) and distinct microbiota profiles, including greater diversity (Shannon Index 0.77 vs 0.25, p=0.031) and higher dysbiosis prevalence (62.1% vs 10%, p=0.015).Anaerobes (Veillonella, Dialister) were more abundant in menopause (p<0.05).Estradiol correlated positively with Lactobacillus percentage (Rho=0.334,p=0.010) and negatively with diversity (Rho=-0.310,p=0.017), though subgroup analyses were non-significant.Conclusion: Lower estradiol levels are significantly associated with altered vaginal microbiota, including reduced Lactobacillus dominance and increased microbial diversity.While these changes are most evident during the menopausal transition, our findings suggest that menopausal status further modifies this relationship, potentially amplifying the hormonal effects on microbial composition.Together, these results highlight that both declining estradiol levels and menopausal transition collectively contribute to vaginal ecological changes, emphasizing the need for comprehensive hormonal and microbial assessment in management of menopausal problems.

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