Vaginal microbial niche is a dynamic ecosystem, composed by more than 200 bacterial species which are influenced by genes, ethnic background and environmental-behavioral factors. Several lines of evidence have well documented that vaginal microbiome constantly changes over the course of woman’s life, so to exert an important impact on woman quality of life, from newborn to post-menopausal ages. This review aims at analyzing the role of vaginal microbiome in the maintenance of woman’s homeostasis and at tracking critical changes that commonly occur across woman’s lifetime. The role of hormone replacement therapy in the modulation of vaginal microbiome composition and in the improvement of vaginal wellness in postmenopausal women with decreasing levels of circulating estrogen is discussed.

Over the last years, increasing evidence has focused on crucial pathogenetic role of PRL on malignant, premalignant and benign uterine diseases. Studies in animals and humans have documented that PRL receptors (PRL-Rs) are widely expressed on uterine cells and that PRL is directly synthesized by the endometrium under the stimulatory action of progesterone. Uterine PRL secretion is finely modulated by autocrine/paracrine mechanisms which do not depend on the same control factors implied in the regulation of PRL secretion from pituitary. On the other hand, PRL is synthesized also in the myometrium and directly promotes uterine smooth muscle cell growth and proliferation. Therefore, PRL and PRL-Rs appear to play an important role for the activation of signaling pathways involved in uterine cancers and preneoplastic lesions. Circulating PRL levels are reportedly increased in patients with cervical or endometrial cancers, as well as uterine premalignant lesions, and might be used as discriminative biomarker in patients with uterine cancers. Similarly, increased PRL levels have been implicated in the endometriosis-induced infertility, albeit a clear a causative role for PRL in the pathogenesis of endometriosis is yet to be demonstrated. This evidence has suggested the potential application of dopamine agonists in the therapeutic algorithm of women with malignant, premalignant and benign uterine lesions. This review focuses on the role of PRL as tumorigenic factor for uterus and the outcome of medical treatment with dopamine agonists in patients with malignant and benign uterine disease.

SommarioLa gestione clinico-terapeutica dei pazienti con prolattinoma è basata sul trattamento con dopamino-agonisti (DA), in particolare la cabergolina, data la loro comprovata efficacia biochimica e antitumorale. Il raggiungimento di normali valori di prolattina associato alla significativa riduzione delle dimensioni tumorali, fino alla sua completa scomparsa, può suggerire l’opportunità di sospendere tale terapia nei pazienti trattati per almeno due anni. Tuttavia, è fortemente raccomandato di evitare la sospensione improvvisa del trattamento con DA e di preferire un protocollo di graduale riduzione del dosaggio di DA fino alla definitiva interruzione del trattamento, al fine di consentire la persistenza di normali valori di prolattina nel tempo. Nei pazienti con evidenza di recidiva di iperprolattinemia dopo un primo tentativo di sospensione dei DA, è possibile effettuare un secondo tentativo di sospensione dopo un ulteriore ciclo di trattamento con DA per due anni.