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      Effect of Menopausal Hormone Therapy on the Vaginal Microbiota and Genitourinary Syndrome of Menopause in Chinese Menopausal Women


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          Genitourinary syndrome of menopause (GSM) is a chronic and progressive condition with a series of vulvovaginal, sexual, and lower urinary tract discomforts, mainly due to hypoestrogenism. Menopausal hormone therapy (MHT) has generally been considered as the most effective treatment for GSM. In addition, vaginal microbiota is of particular significance to gynecological and reproductive illnesses and potentially has some intimate connections with GSM. Consequently, we sought to evaluate how MHT impacts the composition and structure of vaginal microbiota while alleviating GSM in Chinese menopausal women aged 45–65 years, which has not been investigated previously. 16S rRNA gene sequencing was performed to analyze microbial diversity and composition using vaginal swabs obtained from 100 menopausal women, classified as MHT women who have been taking tibolone regularly ( n = 50) and non-treated women who never received any treatment ( n = 50). Vaginal Health Index Score (VHIS) and GSM symptoms inquiry were also performed. We found that the vaginal microbial diversity decreased and that the abundance of Lactobacillus increased to be the dominant proportion significantly in the MHT group, in considerable contrast to vaginal microbiota of the non-treated group, which significantly comprised several anaerobic bacteria, namely, Gardnerella, Prevotella, Escherichia-Shigella, Streptococcus, Atopobium, Aerococcus, Anaerotruncus, and Anaerococcus. In this study, women without any MHT had significantly more severe GSM symptoms than those receiving tibolone, especially with regard to vulvovaginal dryness and burning, as well as decreased libido ( P < 0.01). However, there was no significant difference in the severity of urological symptoms between the groups ( P > 0.05). Furthermore, Lactobacillus was demonstrated to be associated with VHIS positively ( r = 0.626, P < 0.001) and with GSM negatively ( r = −0.347, P < 0.001). We also identified Chlamydia ( r = 0.277, P < 0.01) and Streptococcus ( r = 0.270, P < 0.01) as having a prominent association with more serious GSM symptoms. Our study provided an elucidation that MHT could notably alleviate GSM and conspicuously reshape the composition of the vaginal microbiota, which is of extreme importance to clinical practice for the management of GSM.

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          The SILVA ribosomal RNA gene database project: improved data processing and web-based tools

          SILVA (from Latin silva, forest, http://www.arb-silva.de) is a comprehensive web resource for up to date, quality-controlled databases of aligned ribosomal RNA (rRNA) gene sequences from the Bacteria, Archaea and Eukaryota domains and supplementary online services. The referred database release 111 (July 2012) contains 3 194 778 small subunit and 288 717 large subunit rRNA gene sequences. Since the initial description of the project, substantial new features have been introduced, including advanced quality control procedures, an improved rRNA gene aligner, online tools for probe and primer evaluation and optimized browsing, searching and downloading on the website. Furthermore, the extensively curated SILVA taxonomy and the new non-redundant SILVA datasets provide an ideal reference for high-throughput classification of data from next-generation sequencing approaches.
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            QIIME allows analysis of high-throughput community sequencing data.

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              Metagenomic biomarker discovery and explanation

              This study describes and validates a new method for metagenomic biomarker discovery by way of class comparison, tests of biological consistency and effect size estimation. This addresses the challenge of finding organisms, genes, or pathways that consistently explain the differences between two or more microbial communities, which is a central problem to the study of metagenomics. We extensively validate our method on several microbiomes and a convenient online interface for the method is provided at http://huttenhower.sph.harvard.edu/lefse/.

                Author and article information

                Front Microbiol
                Front Microbiol
                Front. Microbiol.
                Frontiers in Microbiology
                Frontiers Media S.A.
                20 November 2020
                : 11
                : 590877
                Department of Gynaecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital , Shanghai, China
                Author notes

                Edited by: Teresa Nogueira, Instituto Nacional Investigaciao Agraria e Veterinaria (INIAV), Portugal

                Reviewed by: Ana Cristina Ferreira, Instituto Nacional Investigaciao Agraria e Veterinaria (INIAV), Portugal; Jeremy Wilkinson, Harvard University, United States

                *Correspondence: Minfang Tao, taomf@ 123456sjtu.edu.cn

                These authors have contributed equally to this work

                This article was submitted to Microbial Symbioses, a section of the journal Frontiers in Microbiology

                Copyright © 2020 Geng, Huang, Jiang, Zheng, Zhou, Zhou, Hu, Li and Tao.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                : 03 August 2020
                : 28 October 2020
                Page count
                Figures: 5, Tables: 4, Equations: 0, References: 42, Pages: 11, Words: 0
                Original Research

                Microbiology & Virology
                menopause,vaginal microbiota,genitourinary syndrome of menopause,menopausal hormone therapy,16s rrna gene sequencing,tibolone


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