A recent review article in npj Women’s Health explored the “menopausal shift” and the complex histological and physiological changes that occur during menopause, highlighting the significant impact of hormonal fluctuations on the microbiome. These shifts, particularly the decline in estrogen levels, lead to disruptions in microbial balance across various body systems, including the gut, skin, oral cavity, and vaginal microbiomes. The review emphasizes the bidirectional relationship between hormones and the microbiome, which plays a critical role in managing menopause symptoms and promoting healthy aging in women.
Background: Addressing the Decade of Healthy Aging
The United Nations has designated 2021-2030 as the Decade of Healthy Aging, urging gender-specific strategies to improve women’s health as they age. Women typically live longer than men but face unique health challenges, particularly during menopause. This transition, usually occurring around age 50, signifies the end of menstruation and is often accompanied by symptoms like hot flashes, mood swings, and an increased risk of cardiovascular disease, osteoporosis, and cognitive issues. The review article also highlights the lesser-discussed impacts on oral health, such as dry mouth and increased vulnerability to infections, that occur due to hormonal changes.
Hormonal Shifts and Their Effect on the Microbiome
During menopause, the body experiences significant hormonal shifts, primarily due to the decline in estrogen levels. Estradiol, the dominant estrogen during the reproductive years, decreases, and estrone produced in adipose tissue becomes the main estrogen. This change affects numerous physiological processes, including metabolism, cardiovascular health, and cognitive function. The review introduces the concept of the estrobolome, a set of gut microorganisms that play a role in metabolizing estrogen, further influencing the body’s estrogen levels and related processes during menopause.
Oral Health and the Menopausal Shift
Estrogen not only influences systemic health but also plays a crucial role in maintaining oral health. It impacts saliva production and composition, which are essential for maintaining oral hygiene and preventing infections. Menopausal women often experience reduced salivary flow, increased oral acidity, and altered bacterial composition in the oral cavity, leading to a higher risk of conditions like periodontal disease, gingivitis, and menopausal gingivostomatitis. The article draws attention to the parallel changes in oral and vaginal tissues, noting that both can experience dryness and increased susceptibility to infections during menopause, requiring targeted therapeutic approaches for oral and vaginal health.
Microbial Disruptions in the Menopausal Body
The review also explores how menopause affects microbial communities across various bodily systems, focusing on the oral, gut, and urogenital microbiomes. While no significant differences in overall oral microbiome composition were found between pre- and postmenopausal women, shifts in specific bacterial species were observed, including alterations in the prevalence of Prevotella copri and Veillonella tobetsuensis. Increased salivary cortisol levels, indicative of stress, were linked to changes in oral bacteria and a heightened risk of periodontal disease in postmenopausal women with psychosomatic disorders.
Beyond the oral cavity, changes in the vaginal microbiome were also significant. The menopausal shift results in a reduction in the dominance of beneficial Lactobacillus species, increasing susceptibility to infections and potentially contributing to conditions like endometrial cancer. These changes are part of a broader “menopause paradox,” where microbial diversity increases, but the dominance of beneficial microbes decreases.
Hormones and Microbial Interactions: A Dynamic Relationship
The relationship between hormones, particularly estrogen, and the microbiome is dynamic and crucial in the context of menopause. Estrogen’s decline not only impacts hormonal regulation but also affects microbial diversity. The interaction between microbial genes and host physiology during menopause remains an area of active research. Bacteria that metabolize estrogen, such as β-glucuronidase-producing microorganisms, can influence the bioavailability of estrogen and related processes, impacting tissues like the vaginal mucosa where beneficial Lactobacillus species are essential for maintaining health.
Research Gaps and the Need for Further Studies
While existing research has provided valuable insights into the connection between estrogen and the microbiome, the exact mechanisms underlying microbial interactions during aging and menopause remain unclear. The review highlights the need for further investigation into how microbial communities influence hormone regulation and, in turn, how hormonal changes impact microbial health. Additionally, most studies in this field have focused on Western populations, with limited research on how menopause affects microbiomes in African, Asian, and Latin American populations. Expanding research to include diverse populations would help create more personalized and effective health interventions.
Conclusion: A Call for Integrated Interventions
The review article underscores the importance of understanding the hormonal and microbial changes that occur during menopause. It advocates for personalized dietary interventions and other health strategies that address both hormonal imbalances and microbial dysbiosis to alleviate menopause symptoms and improve overall health. By integrating insights from hormone regulation and microbiome health, healthcare providers can better support women through this transition, promoting healthier aging and reducing the risk of menopause-related conditions.
As more research is conducted, it is hoped that a more comprehensive understanding of the menopausal shift will lead to improved strategies for managing this critical stage of life.
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