Vaginal microbiota and genitourinary menopausal symptoms: A cross-sectional analysis

Caroline M. Mitchell, Sujatha Srinivasan, Xiang Zhan, Michael C. Wu, Susan D. Reed, Katherine A. Guthrie, Andrea Z. LaCroix, Tina Fiedler, Matthew Munch, Congzhou Liu, Noah G. Hoffman, Ian A. Blair, Katherine Newton, Ellen W. Freeman, Hadine Joffe, Lee Cohen, David N. Fredricks

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Objective: To examine associations between the composition of the vaginal microbiota and genitourinary menopausal symptoms, serum estrogen, and vaginal glycogen. Methods: For this cross-sectional study, 88 women aged 40 to 62 years, enrolled in a hot flash treatment trial, provided vaginal swabs and a blood sample at enrollment. Bacterial communities were characterized using 16S rRNA PCR and deep sequencing targeting the V3-V4 region. Quantities of Lactobacillus crispatus and Lactobacillus iners were measured using qPCR. Self-reported genitourinary symptoms included: presence and severity of individual symptoms and identification of most bothersome symptom. Glycogen was measured fluorometrically in swab eluate. Serum estradiol (E2) and estrone (E1) were measured by liquid chromatography/mass spectrometry. Associations between bacteria, symptoms, glycogen, and serum estrogens were tested by linear regression or Wilcoxon signed-rank test, adjusted for multiple comparisons. Comparisons between groups used Kruskall-Wallis or Fisher's exact test. Results: Of the 88 women, 33 (38%) had a majority of Lactobacillus species, whereas 58 (66%) had any Lactobacillus detected. Over half (53%) reported at least one vulvovaginal symptom (most commonly dryness), but symptoms were not associated with the presence of Lactobacillus species. Women with Lactobacillus-dominant communities had higher unconjugated serum estrone, but no difference in vaginal glycogen levels, compared with those with non-Lactobacillus-dominant communities. Higher serum E2 and E1 were not associated with either higher vaginal glycogen or detection of individual genera. Conclusions: Presence of Lactobacillus-dominant vaginal microbiota was not associated with fewer vulvovaginal symptoms. Serum estrone was higher in women with Lactobacillus dominance, but vaginal-free glycogen was not associated with composition of the vaginal microbiota.

Original languageEnglish (US)
Pages (from-to)1160-1166
Number of pages7
Issue number10
StatePublished - Oct 1 2017

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology


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