Vaginal estrogen is linked to premenopausal-like urinary microbes

In women across menopausal stages, vaginal estrogen therapy is linked to a urinary microbiome that more closely resembles premenopausal profiles, according to a preprint on bioRxiv. Researchers analyzed sequencing and metabolomic data to compare urinary bladder microenvironments among premenopausal women, postmenopausal women, and postmenopausal women using vaginal estrogen. The urinary microbiome differed between pre- and postmenopausal participants. However, at least six weeks of vaginal estrogen was associated with higher levels of urinary lactobacilli and fewer opportunistic pathogens in postmenopausal women. Changes in urinary Lactobacillus species correlated with vaginal pH, and species found in the vagina tended to match those in the bladder. Urinary metabolites also differed across groups, with Lactobacillus iners showing consistently inverse relationships compared to Lactobacillus crispatus, Lactobacillus gasseri, or Lactobacillus jensenii.