Interactions between vaginal, periurethral and urinary microbiota in genitourinary syndrome of menopause and the effects of local estrogen therapy.

In 30 seconds

This prospective study characterized vaginal, periurethral, and bladder microbiota in postmenopausal women grouped by atrophy and symptom status, and assessed changes after 12 weeks of vaginal estriol. At baseline, women with asymptomatic atrophy or symptoms had greater vaginal and periurethral alpha diversity and less Lactobacillus than controls. After estrogen therapy, Lactobacillus abundance increased in vaginal and periurethral samples, and urinary microbiota shifted toward a control-like composition. The findings indicate that microbiota changes in genitourinary syndrome of menopause vary across urogenital compartments, rather than being confined to the vagina.

Key findings

• Vaginal and periurethral alpha diversity was higher in women with asymptomatic atrophy and symptomatic women than in controls and estrogen-treated women.
• Atrophy groups had reduced Lactobacillus and more anaerobic taxa in vaginal and periurethral samples; urinary samples showed Escherichia predominance.
• After 12 weeks of vaginal estriol, Lactobacillus abundance increased in vaginal and periurethral compartments, while urinary profiles shifted toward controls.
• Periurethral Streptococcus abundance correlated with sexual symptom scores.

Why it matters

The study highlights that microbial patterns associated with genitourinary syndrome of menopause may differ between vaginal, periurethral, and urinary sites. This broader view may help inform research into symptom mechanisms and treatment-related microbial changes, while the observed correlation between periurethral Streptococcus and sexual symptoms remains an association rather than evidence of causation.

What to keep in mind

The abstract does not report participant numbers or detailed effect estimates, limiting assessment of the precision and magnitude of the findings.