Relationship between the symptoms of vulvovaginal epithelial atrophy and the vaginal microbiota in postmenopausal women

Objective. To investigate the vaginal microbiota in postmenopausal women and its relationship to the symptoms of vulvovaginal atrophy (VVA). Subjects and methods. A total of 187 women, who had been postmenopausal for 1-20years, were examined. All the patients signed informed consent forms. The inclusion criteria were the absence of menopausal hormone therapy for 6 months and systemic or local antibacterial therapy for 1 month before starting the study. The studies included cytological examination of vaginal wall smears, followed by estimation of the vaginal epithelium maturation index, vaginal pH value, and polymerase chain reaction for estimating the vaginal microcenosis. Results. Bacterial community Type IV (BC-IV) is associated with the absence of lactobacilli. Vaginal dryness is not a specific symptom for atrophic changes in the vaginal mucosa. The presence or absence of this symptom seems to also depend on the composition of the vaginal microbiota in the postmenopausal period and to be associated with BC-IV. Conclusion. Presentation of the relationship of vaginal symptoms not only to atrophy of the vaginal mucosa, but also to the specific features of its microflora will be able to personalize the management of postmenopausal women: those with BC-IV without atrophic changes in the vaginal mucosa from the standpoint of therapy for bacterial vaginosis, but if there are atrophic changes, local hormone therapy with estriol is the first-line treatment of choice.

vulvovaginal epithelial atrophy, vaginal dryness, postmenopausal vaginal microbiota, postmenopause, lactobacilli