Background: Probiotics may enhance the effects of exogenous oestrogens such as hormone replacement therapy and isoflavones, and may lead to improvements in menopausal symptoms, and cardiovascular, bone and vaginal health. Objectives: To examine the effects of probiotics on oestrogen-related pathologies and explore whether probiotics influence the effects of exogenous oestrogenic substances. Search strategy: Searches of EMBASE, MEDLINE, Cochrane Library, Scopus, and Web of Science were performed. Selection criteria: Studies reported on the effects of probiotics, or probiotics plus oestrogenic substances such as estriol or isoflavones, among perimenopausal or recently postmenopausal women. Data collection & analysis: All findings were narratively synthesised; 7 studies were examined via meta-analysis which examined the effects of probiotics versus placebo. Main results: Thirty-nine studies contributed data from 3,187 women. Probiotics were associated with improvements in menopausal symptoms, urogenital conditions, bone health, and enhancements in the efficacy and safety of estriol and isoflavones. Meta analysis demonstrated large effects of probiotics on menopausal symptoms (total score): [standardised mean difference (SMD)= -0.82, (95% CI -0.52 to -1.09)], vasomotor symptoms: [SMD= -0.96, (95% CI -1.25 to -0.68)], psychological symptoms: [SMD=-0.51, (95% CI -0.95 to -0.08)], vaginal dryness: [SMD=-0.95 (95% CI -1.40 to -0.49)], and vaginal microbiome health (Nugent score): [SMD=-0.91 (95% CI -1.32 to -0.49)]. Meta analysis results were nonsignificant in relation to somatic and sexual symptoms. Conclusions: Findings suggest that probiotics may improve conditions related to low oestrogen levels. Moreover, probiotics may enhance the effects of estriol and isoflavones. While findings are limited by the high risks of bias in the included studies, these results are promising and require further investigation.

Background: The Health & Her app provides menopausal women with a means of monitoring their symptoms, symptom triggers, and menstrual periods, and enables them to engage in a variety of digital activities designed to promote health and wellbeing. The aim of the present study was to examine whether sustained weekly engagement with the app is associated with improvements in menopausal symptoms. Methods: This quasi-experimental study used routinely collected data provided by 1,900 Health & Her app users across a 2-month period. Symptom change from baseline over a period of up to 2 months was the outcome measure. A linear mixed effects model explored whether app engagement was predictive of symptom changes. Secondary analyses explored whether app-usage factors such as total number of days spent logging symptoms, logging triggers, reporting menstrual periods, and using in-app activities were independently predictive of symptom reductions from baseline. Covariates included HRT (Hormone Replacement Therapy) use, hormonal contraceptive use, present comorbidities, age, and dietary supplement use. To examine which types of symptoms were associated with the largest changes in total symptom scores, symptom scores at baseline were evaluated and were split according to specific symptom domains (i.e., psychological, urogenital, vasomotor, and physical). Results: Findings demonstrated that greater engagement with the Health & Her app for 2-months was associated with greater reductions in symptoms over time. Moreover, daily use of in-app activities and logging symptoms and menstrual periods were each independently associated with symptom reductions. Of the four symptom domains assessed, reporting psychological symptoms at baseline were associated with the greatest reductions in total symptom scores. Conclusions: This study has demonstrated that greater weekly engagement with the app was associated with greater reductions in symptoms. It is recommended that women be made aware of menopause-specific apps, such as that provided by Health & Her, to support them to manage their symptoms.

Evidence suggests that probiotics may enhance the effects of exogenous oestrogens such as hormone replacement therapy and isoflavones, and may lead to improvements in menopausal symptoms, and cardiovascular, bone and vaginal health. The present review aimed to examine the effects of probiotics on menopausal health outcomes and explore whether probiotics may influence the effects of exogenous oestrogenic substances. The following databases were searched: Google Scholar, EMBASE, MEDLINE, Cochrane Library, Scopus, and Web of Science. Thirty-nine studies met the inclusion criteria and contributed data from 3,187 menopausal women. All research was narratively synthesised, and 7 studies were examined via meta-analysis which examined the effects of probiotics versus placebo on menopausal symptoms, including vaginal, vasomotor, and psychological symptoms. Probiotics were associated with improvements in menopausal symptoms, urogenital conditions, and bone health. Meta analysis demonstrated large effects of probiotics on menopausal symptoms (total score), vasomotor symptoms, psychological symptoms, vaginal dryness, and vaginal microbiome health. Findings indicated that probiotics could enhance the efficacy and safety of estriol and isoflavone supplementation on urogenital and menopausal symptoms. These findings suggest that probiotics may offer benefits to menopausal and postmenopausal women, by improving menopausal symptoms and conditions related to low oestrogen levels. Moreover, probiotics may enhance the effects of estriol and isoflavones, potentially benefitting women at risk of oestrogen-dependent cancer where high-dose HRT is contraindicated. While findings are limited by the high risks of bias in the included studies, these results are promising and require further investigation through controlled experimental and observational research.