Features of the vaginal microbiome in postmenopausal vulvovaginal atrophy

Objective: to study the features of the vaginal microbiome in women with postmenopausal OVA and to conduct a comparative analysis of the microbiota in groups with varying degrees of severity of symptoms.

Materials and methods: a prospective study was conducted involving 212 naturally postmenopausal patients (age 48–59 years) with moderate IVA. The degree of symptoms was assessed using the VSQ questionnaire and the vaginal Health index. The state of microbiocenosis was analyzed by PCR “Femoflor 16”. The patients were divided into three groups according to the severity of symptoms: mild (≤5 symptoms, n=85), moderate (6-10, n=94) and severe (≥11, n=33).

Results: a clear correlation was found between the severity of the symptoms of IVA and the nature of dysbiotic changes. In the group with severe symptoms, 90.9% of patients were diagnosed with moderate or severe aerobic/mixed dysbiosis with a predominance of Gardnerella vaginalis, Prevotella bivia, Porphyromonas spp. and Streptococcus spp., as well as a significant decrease in lactobacillus levels (median — 10^3.3 CFU/ ml). In the group with mild symptoms, 65.9% had normocenosis or conditional normocenosis, but the total bacterial mass was reduced (median — 10^4–5 CFU/ml). In 15.4% of patients, “silent atrophy” (objective signs of IVA in the absence of complaints) with a variable state of the microbiota was detected.

Conclusion: the severity of clinical manifestations of BBA in postmenopausal women is associated with specific changes in the vaginal microbiota: a pronounced symptom complex correlates with dysbiosis and inhibition of lactobacillar flora. The data obtained substantiate the need for a comprehensive diagnosis, 

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