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FEATURES OF THE VAGINAL MICROBIOTA IN POSTMENOPAUSAL WOMEN
Zubaydulloeva Zarnigor Khamzaevna
Kamalova Zarnigor Samaritdinovna
Scientific advisor: prof.
Khudoyarova D.R.
Samarkand State Medical University, Samarkand, Uzbekistan
https://doi.org/10.5281/zenodo.12577288
Annotation.
In current studies, the prevailing opinion is that changes in the vaginal
microbiota affect the health of postmenopausal women and significantly provoke the
development of vulvovaginal atrophy, vaginal dryness, sexual health and overall quality of life.
The composition of the microbiota is one of the main features of the vaginal biocenosis in
relation to its structure and dynamics, including the influence of ethnicity, vaginal
physiological status and genetic predisposition of a woman. Recently, there has been evidence
that after menopause, the taxonomic composition of the vaginal microbiota significantly
decreases the number of species, mainly due to the reduction of Lactobacillus taxa, but at the
same time the species diversity increases. Significant associations have been identified
between the stage of menopause and the types of bacterial communities. Thus, if in
perimenopausal women the types of conditions of the CST IV-A or CST Lactobacillus gasseri
communities were more often detected, then in postmenopausal women - CST IV-A, CST with
a predominance of Lactobacillus crispatus. L.gasseri/Lactobacillus predominant
postmenopausal women had the lowest odds of vaginal dryness (odds ratio 0.36, 95%
confidence interval 0.12-1.06) and low libido (odds ratio 0.28, 95% confidence interval 0.10-
0.74).
Keywords:
vaginal microbiota, postmenopause, Lactobacillus, treatment.
Aim of the research.
To study the dynamics of the vaginal microbiota depending on the
postmenopausal stage.
Relevance.
There is an opinion that a decrease in the number of lactobacilli and a
predominance of anaerobes leads to symptoms of bacterial vaginosis. Thus, in a culture-
independent assessment of the human vaginal microbiome, Prevotella was found as one of the
dominant genera. It was found that changes in the microbiota associated with hormonal
changes in postmenopause are similar to vaginal dysbiosis in pelvic inflammatory diseases,
infections caused by HIV and papillomavirus person, as well as during pregnancy. In contrast,
a study by S. Hillier and R. Lau in 1997 showed that species of lactobacilli and other bacteria
associated with vaginosis are less common in postmenopausal women than those found in
women of childbearing age [13]. Only 6.3% of postmenopausal women who did not receive
hormone replacement therapy and 5.4% of those who received it tested positive for bacterial
vaginosis. In the vagina, some examples of synergistic relationships occur, for example, in the
case of Prevotella bivia and Gardnerella vaginalis.
Changes in the vaginal microbiota have been associated with changes in the urinary
tract microbiota and the development of genitourinary syndrome after menopause. However,
some studies have not found a link between the severity of vaginal symptoms, markers of
mucosal inflammation and the type of microbiota. Undoubtedly, data on the correlation
between menopause and the microbiome can help in the diagnosis of vulvovaginal atrophy
and improve methods of preventing and treating menopause-related diseases.
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Materials and methods.
In order to study changes in the vaginal microbiota depending
on the stage of postmenopause, we examined 100 women at various stages of postmenopause
at STRAW+10. All patients met the eligibility criteria and signed voluntary informed consent.
The women were divided into 2 comparable groups (study and control) in order to study the
results of treatment.
Results and discussion.
The analysis of changes in the composition of the vaginal
microbiota depending on menopausal age was carried out taking into account the frequency
of detection and the ratio (proportions) of normoflora and opportunistic microorganisms.
According to the results of all studies, in both groups, the total bacterial mass ranged
from 106 to 108 CFU/ml, which corresponded to normal values. Since all women were
examined before treatment and there were no significant differences in the composition of the
microbiota, the assessment was carried out by the sum of the results of both groups. In both
the main and control stages, women with stage +1a, +1b were completely free of lactobacilli.
However, lactobacilli were detected in 15.8% of patients with the +1c stage and in 9.1% of
patients with the +2 stage in the study group, and in 20 and 13.3% of women of the same age
periods in the control group. The absolute result is slightly below the norm - 105.9 gene
equivalents/ml was noted in all cases. The relative result in all cases was -1.0 (69-93%),
which corresponded to normal values, from 105 to 106 CFU/ml, or -0.3-0 (70-100%). Results
of the analysis of changes in the composition of facultative anaerobic microorganisms
according to Femoflor 16 depending on menopausal age. In all patients whose vaginal
microbiota contained lactobacilli, only Streptococcus spp. and Staphylococcus spp. had
facultative anaerobes, and Enterobacteriaceae were completely absent. The amount of
Streptococcus spp. was 105.6, or -0.3 (38-52%), and Staphylococcus spp. was 103.1 CFU/mL,
or -2.1 (0.1-0.2%). In women who did not have lactobacilli in the vaginal microbiota, the
group of facultative anaerobes is represented entirely by Enterobacteriaceae in amounts
equal to 10x4.4 CFU/ml, or -4.0 (0.1%), which corresponds to normal values - less than 100-
103 CFU/ml, or less than -3 (0.1%). Thus, the composition of obligate anaerobes in the vagina
changed insignificantly depending on menopausal age. The group of lactobacilli was
completely absent in women with stages +1a and b, but was detected in a small proportion of
patients in the later stages of menopause. The ratio of all other microorganisms also
depended on the presence of lactobacilli. In the vast majority of cases in postmenopausal
women of all age groups, the obligate-anaerobic microbiota is represented by
Enterobacteriaceae and Streptococcus spp. The number of Staphylococcus spp. increased
sharply by the +2 stage. The change in the composition of obligate-anaerobic microorganisms
depending on menopausal age is more significant.
Conclusion
. With the increase in menopausal age, all the women examined experienced
an impoverishment of the composition of the vaginal microbiota. In the group of obligate
aerobes, Lactobacillus spp. and Enterobacteriaceae were completely replaced by
Streptococcus spp. and Staphylococcus spp., the number of which increased. A significant
impoverishment of the composition occurred in the group of obligate anaerobes. If at stages
+1a, b this group is almost equally represented by 5 communities of microorganisms (G.
vaginalis + P. bivia + Porphyromonas and Peptostreptococcus spp., Megasphaera spp. +
Veillonella spp. + Dialister spp., Mobiluncus spp. + Corynebacterium spp., Lachnobacterium
spp. + Clostridium spp.), then at stage +1c 3 groups prevailed in the total bacterial mass (G.
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vaginalis + P. bivia + Porphyromonas and Peptostreptococcus spp., Megasphaera spp. +
Veillonella spp. + Dialister spp., Mobiluncus spp. + Corynebacterium spp.). At the
postmenopausal stage +2, the main part of the total bacterial mass was made up of 2 groups of
microorganisms: G. vaginalis + P. bivia + Porphyromonas and Peptostreptococcus spp.
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