The Research On Genitourinary Syndrome Of Menopause And Vaginal Microbiome

OBJECTIVES:To investigate symptoms of genitourinary syndrome of menopause and vaginal microecology in perimenopausal and postmenopausal women,and to fully understand the characteristics of GSM and the distribution of vaginal microorganisms in women with different menopausal states as well as the effect of tibolone on GSM and vaginal microbiome.METHODS:There were perimenopausal and postmenopausal women who attended physical examination or climacteric clinic in the Shanghai Jiaotong University Affiliated Sixth People’s Hospital from December2015 to December 2018 selected as the subjects of the study.The general demographic characteristics and genitourinary symptoms were surveyed,the structure and function of vaginal microbiome were analyzed by 16S sequencing.RESULTS:The prevalence of GSM was 30.8%,the most frequent symptom was decreased sexual desire,followed by vulvovaginal symptoms,and the symptom of lower urinary tract was the lowest,and all of them were mild mainly.Menopause(P=0.007;OR,1.523),the number of abortion≥2(P=0.035;OR,1.419),BMI≥30 kg/m~2(P=0.032;OR,1.914)and diabetes(P=0.041;OR,1.938)were risk factors for GSM.Vaginal microbiome was clustered into four community clusters,which in the perimenopausal period were similar to those in the early postmenopausal period,but changed in the late postmenopausal period(P<0.01):the abundance of Lactobacillus decreased and the abundance of conditional pathogenic bacteria increased,and the metabolic function was significantly more active.After one-year tibolone treatment,GSM(P<0.01)and the condition of vaginal atrophy(P<0.001)were improved,besides,vaginal microbial diversity was decreased,Lactobacillus was considered as a marker microorganism,and DNA replication and repair were involved.CONCLUSION:The years of menopause are related to the increase in the prevalence of GSM,and the vaginal microbiome has also changed with the progression of menopause.Tibolone can improve the health status of genitourinary tract in middle-aged and elderly women,especially for the women in the early menopause stage should be given timely and effective intervention.