RELATIONSHIP BETWEEN VAGINAL MICROBIOTA AND METABOLIC DISEASES IN POSTMENOPAUSAL WOMEN

Abstract

The vaginal microbiota plays a crucial role in maintaining women's gynecological and systemic health. Composed predominantly of Lactobacillus species, this microbial community is responsible for creating an acidic environment that protects against infection and inflammation. However, changes in this ecosystem, known as vaginal dysbiosis, can lead to complications that go beyond reproductive health, also influencing metabolic conditions. The objective of this study is to identify how changes in microbial composition are associated with the development of these conditions, contributing to the advancement of the understanding of the interactions between hormonal factors, microbiota and metabolism. To this end, a structured systematic review was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The guiding question was developed using the PICO approach: "What is the influence of modifications in the vaginal microbial ecosystem on the prevalence of metabolic diseases in women of postmenopausal age?". The eligibility criteria considered articles published between 2010 and 2025, in English, Portuguese or Spanish. Original studies, literature reviews, and meta-analyses addressing the interaction between the vaginal microbiota and metabolic conditions in postmenopausal female populations were included. Studies focusing exclusively on gut microbiota or conducted in animal models were excluded. The searches were carried out in the PubMed, Google scholar and Scielo databases, The results state that vaginal dysbiosis is a determining factor for the increase in the prevalence of metabolic diseases in postmenopausal women. Robust evidence was identified that the reduction of Lactobacillus spp., in special species such as Lactobacillus crispatus, is associated with an increase in vaginal pH, favoring the hydration of pathogenic and inflammatory microorganisms. This process not only compromises vaginal health but also triggers systemic inflammation, a central mechanism in the pathogenesis of metabolic conditions such as obesity, type 2 diabetes, and insulin resistance. Thus, it was evidenced that Despite the advances, methodological limitations, such as the heterogeneity of the studies included, reinforce the need for future research to better understand the causal relationships and develop practices. We conclude that the vaginal microbiota plays an essential role in metabolic regulation in postmenopausal women.