Discover how menopause transforms the microbiome and its crucial role in shaping health solutions for women—personalized interventions may hold the key to better aging outcomes.
Review: Menopausal shift on women’s health and microbial niches. Image Credit: ClareM / Shutterstock
In a recent review article in the journal npj Women’s Health, researchers described the ‘menopausal shift’ and highlighted histological and physiological changes women face during menopause. These hormonal changes alter the metabolism and composition of the microbiome, and understanding these interactions is key to alleviating the symptoms of menopause and enhancing overall well-being through personalized dietary and other interventions. The article emphasizes the bidirectional relationship between hormones and the microbiome as a critical factor in this process.
Background
The United Nations has designated 2021-2030 as the Decade of Healthy Aging, emphasizing the need for gender-specific strategies to support women’s health as they age. Women often live longer due to biological factors and healthier behaviors but face unique challenges during aging. Menopause, typically occurring around age 50, marks the end of menstruation and brings symptoms like hot flashes, mood changes, and increased risk of various health issues, including cardiovascular and bone disorders. The review highlights that these risks also extend to oral health, contributing to problems like dry mouth and infections.
The human body hosts a complex microbiome that is critical to maintaining health. Hormonal shifts during menopause can disrupt this balance, leading to changes in the microbiome of the gut, skin, and other areas. This disruption, or dysbiosis, can influence overall health and has been linked to certain gut microorganisms' metabolism of hormones like estrogen. Addressing these changes is vital for promoting healthy aging in women. This underscores the need for integrated interventions targeting both microbial balance and hormone regulation.
Changes in biology during menopause
During menopause, significant biological changes occur due to declining estrogen levels. Estradiol, the dominant estrogen during reproductive years, decreases, and estrone, produced in adipose tissue, becomes the primary estrogen. This hormonal shift affects various body systems, increasing risks of osteoporosis, cardiovascular disease, and cognitive impairments.
Oral health is also impacted. Estrogen influences saliva production and composition, crucial for maintaining oral health. Menopausal women often experience reduced salivary flow and increased oral acidity, leading to higher risks of dental issues like caries and periodontal disease. The gingival tissues, affected by hormonal changes, become more prone to inflammation and bacterial infections, contributing to conditions like gingivitis and menopausal gingivostomatitis. Additionally, the article draws parallels between changes in oral epithelial tissues and those observed in vaginal mucosa, suggesting shared mechanisms of hormonal influence.
Moreover, menopause is linked to changes in oral epithelial tissues, similar to those in the vaginal mucosa, which can result in dryness, burning sensations, and increased susceptibility to infections. Preventive oral care and targeted therapies are essential to address these issues and improve oral health outcomes for aging women.
Alterations to the microbiome
The oral microbiome, a complex ecosystem of microorganisms in the mouth, can be influenced by hormonal changes, especially during menopause. Hormonal fluctuations may alter saliva production and composition, affecting the balance of oral bacteria. While no significant differences were found in the overall composition of the oral microbiome between pre- and postmenopausal women, notable shifts in specific bacterial species, such as Prevotella copri and Veillonella tobetsuensis, were observed.
Salivary cortisol, a stress marker, was higher in postmenopausal women with psychosomatic disorders, potentially altering oral bacterial activity and increasing the risk of periodontal disease. Specific bacteria like Porphyromonas gingivalis were less prevalent in women without periodontal disease, suggesting protective microbial interactions. The review also discusses fungal populations, particularly Candida albicans, noting their potential to proliferate during menopause and contribute to conditions like burning mouth syndrome.
Beyond the oral cavity, menopause also affects the gut and urogenital microbiomes. The vaginal microbiome experiences reduced dominance of beneficial Lactobacillus species, increasing susceptibility to infections and possibly contributing to conditions like endometrial cancer. These shifts are part of a broader "menopause paradox," where microbial diversity increases but beneficial microbial dominance declines.
Hormones and the microbiome
Estrogen plays a vital role in women’s life stages, such as puberty, pregnancy, and menopause. As women age, microbiome diversity declines, but diet, habits, immune responses, and hormone levels influence microbial changes. During menopause, thinning and drying of mucosal tissues cause imbalances in vaginal and oral bacteria, which can be alleviated by hormone therapy. Estrogen and microbiomes interact dynamically, with bacteria capable of activating stored estrogen, impacting estrogen-dependent processes.
Microorganisms metabolize estrogen using enzymes like β-glucuronidase, influencing estrogen availability and related physiological processes. This affects areas like the vagina, where estrogen promotes beneficial Lactobacillus. However, the interaction between microbial genes and the host during aging remains unclear. The review highlights the need for further research into how microbial communities metabolize hormones and influence health outcomes.
Estrogen decline during menopause can lead to oral tissue inflammation and microbial imbalance. Certain oral bacteria can metabolize steroid hormones, potentially causing oral dysbiosis. Research highlights estrogen and progesterone's impact on oral bacteria, but the exact mechanisms are still under investigation. Additionally, diversity in menopausal microbiome research is limited, mostly focusing on Western populations. Including diverse populations from Africa, Asia, and Latin America could provide a broader understanding of menopause's global effects on the microbiome, leading to more personalized health interventions.
Conclusions
Menopause involves hormonal changes that affect women's health and the microbiome, particularly in the oral, intestinal, and urogenital areas. Hormonal fluctuations and microbial interactions are bidirectional and influence disease risk and symptoms. Understanding these dynamics can lead to targeted therapies, improving menopausal women's health and quality of life. The review emphasizes the importance of personalized, microbiome-focused interventions to mitigate health risks and enhance well-being during this life stage.
Journal reference:
- Menopausal shift on women’s health and microbial niches. Nieto, M.R., Rus, M.J., Areal-Quecuty, V., Lubián-López, D.M., Simon-Soro, A. npj Women’s Health (2025). DOI: 10.1038/s44294-024-00050-y, https://www.nature.com/articles/s44294-024-00050-y