Addressing painful sex during menopause

As women age, they are more susceptible to vaginal dryness and pain during intercourse because of vulvovaginal atrophy (VVA). A new study suggests that ospemifene and systemic hormone therapy both result in improving VVA symptoms and likely improve the vaginal microbiome by reducing potentially harmful bacteria and increasing health-promoting microorganisms. 

It is estimated that VVA occurs in approximately 50% of menopausal women. This undertreated chronic condition is the result of a reduction in circulating estrogen levels, which leads to thinning of the vaginal walls and less lubrication of the vagina. Ultimately, these modifications lead to symptoms such as vaginal dryness and dyspareunia, which can be associated with itching and burning sensations. Vaginal lubricants and moisturizers, as well as vaginal estrogens, can provide some relief, depending on the severity of symptoms.

More recent studies suggest that the composition of the vaginal microbiome may play an integral role in VVA. Compared with women without VVA, the vaginal microbiome of women with mild or moderate atrophy is usually characterized by a marked reduction of lactobacilli (healthy microorganisms), along with an increase of other opportunistic bacteria such as Gardnerella, Streptococcus, and Prevotella. In this new small study, researchers aimed to compare the vaginal microbiome profiles of women suffering from VVA with those of healthy postmenopausal women to assess the effect of ospemifene (a selective estrogen-receptor modulator) and systemic hormone therapy on the composition of the vaginal microbiome. They confirmed that the vaginal microbiome of women with VVA differs significantly from that of healthy postmenopausal women and that ospemifene and hormone therapy may lead to a condition of vaginal well-being by reducing potentially harmful bacteria and increasing health-promoting microorganisms. Further studies are needed to confirm how the vaginal ecosystem is modified by this selective estrogen-receptor modulator.

Abstract

Objectives: This study aimed (i) to compare the vaginal microbiome profiles of women suffering from vulvovaginal atrophy with that of healthy postmenopausal women and to (ii) assess the effect of ospemifene and systemic hormone treatment on the composition of the vaginal microbiome.

Methods: Sixty-seven postmenopausal women attending the Gynecology Clinic of Azienda Ospedaliero-Universitaria of Bologna (Italy) were enrolled. Of them, 39 received a diagnosis of atrophy and 28 were considered healthy controls. In the group of atrophic women, 20 were prescribed ospemifene and 19 received hormone treatment. The vaginal health index was calculated, and a vaginal swab was collected for the assessment of vaginal maturation index and the analysis of vaginal microbiome through 16S rRNA gene sequencing. Clinical/microbiological analyses were repeated after 3 months of treatment.

Results: The vaginal microbiome of atrophic women was characterized by a significant reduction of Lactobacillus (P = 0.002) and an increase of Streptococcus (P = 0.008) and Sneathia (P = 0.02). A positive correlation between vaginal health index/vaginal maturation index and Lactobacillus abundance was found (P = 0.002 and P = 0.035, respectively). Both therapeutic approaches effectively improved vaginal indices. Systemic hormone treatment induced changes in minority bacterial groups of the vaginal microbiome, whereas ospemifene was able to eliminate specific bacterial taxa, such as Staphylococcus (P = 0.04) and Clostridium (P = 0.01). Both treatments induced a trend in the increase of bifidobacteria.

Conclusions: The vaginal microbiome of atrophic women differs significantly from that of healthy postmenopausal women. Ospemifene may lead to a condition of vaginal health, likely characterized by the reduction of "potentially harmful" bacteria.

Reference

Stefania Alvisi, Camilla Ceccarani, Claudio Foschi, Maurizio Baldassarre, Alessandra Lami, Marco Severgnini, Tania Camboni, Clarissa Consolandi, Renato Seracchioli, Maria Cristina Meriggiola. Effect of ospemifene on vaginal microbiome in postmenopausal women with vulvovaginal atrophy. Menopause. 2023 Jan 24. doi: 10.1097/GME.0000000000002150. Online ahead of print.  

Content created February 2023