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The Vaginal Microbiota in Menopause

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Textbook of Aging Skin

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Abstract

Over a woman’s life span, the vagina microbiota will be in constant flux as the ecosystem is buffeted by a variety of both internal and external insults that have the potential to modulate the vaginal milieu. Hormonal changes are a major influence, ethnicity influences the microbiota, and many external factors may affect the composition of the microbiota including the use of personal hygiene products or medications. After menopause, the vagina is likely to harbor more commensal species than during the reproductive years; the vaginal flora of postmenopausal women is altered, often being colonized by potentially pathogenic organisms. Hormone replacement therapy (HRT) can provide benefits to the ecosystem of the lower genital tract. After menopause, estrogen depletion elevates vaginal pH, reduces vaginal colonization by lactic acid-producing microbes, and facilitates colonization by enteric organisms. This increases the risk of urinary tract infections (UTIs), a factor that contributes to incontinence in elderly women. HRT restores vaginal pH and reestablishes normal vaginal microbiota in postmenopausal women, thereby promoting a more healthful vaginal ecosystem. By better understanding the dynamics of vaginal environment in all stages of life and by identifying those events that promote disease, there is hope that more effective therapies can be developed to promote vaginal health throughout a woman’s life.

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Authors and Affiliations

  1. The Procter & Gamble Company, Winton Hill Business Center, 6110 Center Hill Avenue, Cincinnati, OH, 45224, USA

    Miranda A. Farage, Kenneth. W. Miller & Yuli Song

  2. Infectious Diseases, Wayne State University, Detroit, MI, USA

    Jack Sobel

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  1. Miranda A. Farage
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  2. Kenneth. W. Miller
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  3. Yuli Song
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  4. Jack Sobel
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Correspondence to Miranda A. Farage .

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  1. Procter & Gamble Co., Cincinnati, Ohio, USA

    Miranda A. Farage

  2. Procter & Gamble Co., Cincinnati, Ohio, USA

    Kenneth W. Miller

  3. Department Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA

    Howard I. Maibach

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Farage, M.A., Miller, K.W., Song, Y., Sobel, J. (2015). The Vaginal Microbiota in Menopause. In: Farage, M., Miller, K., Maibach, H. (eds) Textbook of Aging Skin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27814-3_84-2

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