A role for the endometrial microbiome in dysfunctional menstrual bleeding
This study aimed to characterise the microbial community within the endometrial cavity and endocervix in women with menorrhagia or dysmenorrhea. Paired endocervical and endometrial biopsy samples were collected from women undergoing operative hysteroscopy and/or laparoscopy. Samples were cohorted based on pathology, indications for surgery, and histological dating of the endometrium. Samples were interrogated for the presence of microbial DNA using a two-step next generation sequencing technology approach to exploit the V5–V8 regions of the 16S rRNA gene. Pyrosequencing revealed that the endocervix and endometrium share a minor microbial community, but that each site harbours a separate and distinct microbial population (p = 0.024). This was also the case for women with menorrhagia and dysmenorrhea (p = 0.017). Lactobacillus spp. were the most abundant microbial taxa present in 50% of the cohorts, and across all endocervical groups. Members of the genera Prevotella, Fusobacterium and Jonquetella were the most abundant taxa identified in samples collected from nulliparous women. It can be concluded that the female upper genital tract is not sterile. Microbial community profiling revealed differences in the endometrial microbial community profiles for: (1) the endocervix compared to the endometrium, and (2), women with menorrhagia versus dysmenorrhea. The distinct microbial community profiles in these women may offer insight into the pathology and clinical management of dysfunctional menstrual bleeding.
KeywordsMenorrhagia Dysmenorrhea Microbial community profile Lactobacillus sp. Endometrium
The authors wish to thank Wesley Hospital theatre staff who facilitated collection of the genital tract samples. We wish to acknowledge the Australian Centre for Ecogenomics for 454 pyrosequencing and Professor Philip Hugenholtz and Dr Fiona May. This work was performed in the Thorsen Group Women’s Health Laboratory.
This work was performed in the Thorsen Group Women’s Health Laboratory and was supported by a Wesley Research Institute Grant (2011-18).
Compliance with ethical standards
Conflict of interest
No competing financial interests exist.
All procedures performed in studies involving human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- Holmes KK, Sparling PF, Mardh P, Lemon ST, Stamm SE, Piot P, Wasserheit JN (eds) (2008) Sexually transmitted diseases. McGraw-Hill, New YorkGoogle Scholar
- Holt JG, Krieg NR, Sneath PHA, Staley JT, Williams ST (eds) (2010) Bergey’s manual of systematic bacteriology. Williams and Wilkins, BaltimoreGoogle Scholar
- Kuczynski J, Stombaugh J, Walters WA, Gonzalez A, Caporaso JG, Knight R (2012) Using QIIME to analyze 16S rRNA gene sequences from microbial communities. Curr Protoc Microbiol Chapter 1: Unit 1E 5Google Scholar
- Pelzer ES, Allan JA (2012) The isolation and identification of microorganisms in the reproductive environment: the potential impact on the IVF culture system and on IVF outcomes. J Clin Embryol 15(3):44–53Google Scholar
- Santiago GL, Tency I, Verstraelen H, Verhelst R, Trog M, Temmerman M, Vancoillie L, Decat E, Cools P, Vaneechoutte M (2012) Longitudinal qPCR study of the dynamics of L. crispatus, L. iners, A. vaginae, (sialidase positive) G. vaginalis, and P. bivia in the vagina. PLoS ONE 7(9):e45281CrossRefPubMedGoogle Scholar
- Speroff L, Fritz MA (2005) Clinical gynecologic endocrinology and infertility. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
- Verstraelen H, Verhelst R, Claeys G, De Backer E, Temmerman M, Vaneechoutte M (2009) Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora. BMC Microbiol 9:116CrossRefPubMedPubMedCentralGoogle Scholar