In a recent review published in npj Women’s Health, researchers explored the “menopausal shift,” emphasizing how hormonal changes during menopause impact women’s microbiomes. These changes, including shifts in the gut, skin, and oral microbiota, are crucial for understanding menopausal symptoms and associated health risks. The review underlines the bidirectional relationship between hormones and the microbiome and the importance of personalized interventions targeting both hormone regulation and microbial balance for improving women’s health during menopause.
The United Nations designated 2021-2030 as the Decade of Healthy Aging, recognizing the need for gender-specific health strategies, especially for women. While women tend to live longer than men due to biological and behavioral factors, they face unique challenges as they age. One of the most significant milestones is menopause, which typically occurs around age 50 and marks the cessation of menstruation. Menopause is accompanied by symptoms like hot flashes, mood swings, and an increased risk of various health problems, including cardiovascular disease, osteoporosis, and cognitive decline.
The review article highlights that these risks also extend to oral health, including issues like dry mouth and infections. A key area of concern is how the hormonal changes during menopause can disrupt the delicate balance of the microbiome, which is essential for overall health.
Hormone-Microbiome Crosstalk: A central concept in this review is the “estrobolome,” a collection of gut microorganisms capable of metabolizing estrogen. These microorganisms directly influence estrogen levels and related physiological processes, such as metabolism, immune response, and tissue health, all of which undergo significant changes during menopause.
As estrogen levels decline during menopause, estrone, primarily produced in adipose tissue, becomes the dominant form of estrogen, replacing estradiol, the primary estrogen during a woman’s reproductive years. This hormonal shift has far-reaching effects, increasing risks for conditions like osteoporosis, cardiovascular disease, and cognitive decline.
The review also explores the impact on oral health, noting that estrogen influences saliva production and composition, which are critical for maintaining oral health. Postmenopausal women often experience reduced salivary flow, increasing the risk of dental issues such as caries and periodontal disease. The gingival tissues, which become more susceptible to inflammation and bacterial infections, also contribute to these conditions. Moreover, the study draws parallels between the changes in oral epithelial tissues and vaginal mucosa, suggesting shared hormonal influences on these areas.
Oral Health: Hormonal fluctuations during menopause can lead to changes in the oral microbiome, which may contribute to oral health issues. The balance of oral bacteria can be affected, particularly with changes in saliva composition. Although no major differences were observed in the overall oral microbiome composition between pre- and postmenopausal women, notable shifts in specific bacterial species were found. For example, Prevotella copri and Veillonella tobetsuensis showed changes in their abundance in postmenopausal women.
Furthermore, salivary cortisol levels, a marker of stress, were higher in postmenopausal women with psychosomatic disorders, potentially altering oral bacterial activity and increasing the risk of periodontal disease. Conversely, certain bacteria, like Porphyromonas gingivalis, were less prevalent in women without periodontal disease, suggesting protective microbial interactions.
In addition to oral health, menopause affects the gut and urogenital microbiomes. The vaginal microbiome, which is dominated by Lactobacillus species, also experiences a decline during menopause, increasing susceptibility to infections and potentially contributing to conditions like endometrial cancer. These changes are part of a broader phenomenon known as the “menopause paradox,” where microbial diversity increases, but beneficial microbial dominance declines.
Oral and Vaginal Microbiome Similarities: The review also highlights the similarities between the oral and vaginal microbiomes, both of which are influenced by estrogen. These two regions share histological and microbial traits, suggesting that hormonal changes affecting one could offer insights into the other. This reinforces the importance of integrative research approaches to better understand the impacts of menopause on microbiome health.
Estrogen plays a crucial role throughout a woman’s life, including puberty, pregnancy, and menopause. As women age, microbiome diversity typically declines, but diet, immune responses, and hormonal fluctuations significantly influence microbial composition. During menopause, the thinning and drying of mucosal tissues in the vaginal and oral areas lead to microbial imbalances. Hormone therapy, particularly estrogen, has been shown to help alleviate some of these imbalances, thus mitigating the health risks associated with menopause.
Additionally, the review discusses how certain bacteria metabolize estrogen, influencing estrogen availability and impacting estrogen-dependent processes, particularly in the vaginal microbiome, where estrogen promotes beneficial Lactobacillus species. However, the review also acknowledges that the full mechanisms by which microbial genes interact with the host during aging are still not completely understood. Further research into how microorganisms metabolize hormones and influence health outcomes is critical for advancing women’s health during menopause.
The review emphasizes that the hormonal changes occurring during menopause significantly affect women’s health by influencing the microbiome, particularly in areas like the oral cavity, gut, and urogenital tract. The interactions between hormones and the microbiome are complex and bidirectional, influencing disease risks and symptoms. Understanding these dynamics is essential for developing targeted therapies and personalized interventions to improve menopausal women’s health and quality of life. The review advocates for microbiome-focused strategies, such as hormone therapy and dietary interventions, to mitigate health risks and promote well-being during this crucial stage of life.
By integrating personalized care that addresses both hormonal and microbiome health, it is possible to enhance the health outcomes of aging women and improve their overall quality of life.
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