Topical interventions on Vaginal Microbiota and Metabolome in Postmenopausal Women effective

Use of vaginal estradiol tablets resulted in substantial changes in the vaginal microbiota and metabolome with a lowering in pH according to the latest research published in JAMA Network Open. This was particularly found in women with high-diversity bacterial communities at baseline.

In the Menopause Strategies-Finding Lasting Answers for Symptoms and Health (MsFLASH) trial network's Vaginal Health Trial of treatment for moderate to severe vaginal symptoms of menopause, no significant difference in symptom reduction was seen between estradiol vaginal tablet or vaginal moisturizer and placebo: all 3 groups had similar improvement.

While both hormonal and nonhormonal treatments have been shown to improve postmenopausal vaginal symptoms, the lack of difference between estradiol and placebo was surprising. The placebo gel used in the trial had high lubricity and low pH, while the moisturizer also had low pH; both properties may contribute to decreased symptoms via biological effects that differ from estradiol.

The analysis by Sujatha Srinivasan et. Al conducted a subset post hoc analysis of participants from the MsFLASH Vaginal Health Trial to evaluate the effect of topical interventions for genitourinary syndrome of menopause on the microbiota and metabolome, and to assess whether larger changes in pH and vaginal maturation index in the estradiol group reflect other changes in the vaginal microbiota and metabolome that might impact genitourinary health.

Women were enrolled between April 2016 and February 2017; final follow-up visits occurred in April 2017.

The primary outcome was change over 12-weeks in severity of MBS selected by participants at enrollment, including pain with penetration, vaginal dryness, and vulvovaginal irritation, itching, or pain. Symptom severity was rated from 0 to 3, signifying none, mild, moderate, or severe

After 12 weeks, the microbiota was dominated with Lactobacillus and Bifidobacterium communities among 36 women (80%) in the estradiol group, compared with 16 women (36%) using moisturizer and 13 women (26%) using placebo.

The composition of vaginal fluid metabolites also varied after 12-weeks among women in the estradiol group with significant changes in 90 of 171 metabolites measured (53%) (P < .001), including an increase in lactate.

The 12-week pH among women in the estradiol group was lower vs placebo but not in the moisturizer group vs placebo.

There was a decrease in pH from baseline to 12-weeks within the moisturizer and placebo groups. Women with high-diversity bacterial communities at baseline exhibited a greater median change in pH compared with women with low-diversity communities.

"This secondary analysis of a randomized clinical trial found that use of vaginal estradiol tablets resulted in substantial changes in the vaginal microbiota and metabolome with a lowering in pH, particularly in women with high-diversity bacterial communities at baseline.

Low pH moisturizer or placebo did not significantly impact the vaginal microbiota or metabolome despite lowering the vaginal pH. Estradiol use may offer additional genitourinary health benefits to postmenopausal women,"the authors concluded.