Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article

Abstract

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter, Escherichia coli, Candida, and Gardnerella). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC.

Vulnerability of the industrialized microbiota

“…There is growing evidence that the use of beneficial bacteria is a promising path forward for managing pathogenic microbes in humans (97). Probiotics can reduce the duration and severity of infectious diarrhea and may be an effective alternative to antibiotics in the treatment and prevention of bacterial vaginosis (98,99). A synbiotic mixture of Lactobacillus plantarum and fructo-oligosaccharides reduced the incidence of sepsis and lowered rates of respiratory tract infection in a cohort of infants from rural India (100).…”

Research Article <i>Lactobacillus</i> <i>crispatus</i> protects against bacterial vaginosis

“…Bacterial vaginosis is one of the most common causes of genital discomfort in women (Kim and Park, 2017;Reid, 2018). Previously, the term bacterial vaginosis was used to describe a syndrome characterized by the presence of malodorous discharge, without apparent inflammation, resulting from complex alterations in the vaginal microbiota (Eschenbach et al, 1988).…”

“…Therefore, it appears that each woman can have a specific vaginal microbiota pattern in response to different situations and unique adversities, justifying the differences in the BV patterns observed. Considering that many cases are asymptomatic, other cases do not respond to antibiotics and that even in cases that are responsive, the antibiotic may not prevent recurrence (Kim and Park, 2017;Reid, 2018), many questions about the etiology and evolution of BV syndrome persist.…”

“…Although antibiotics contribute to a decrease in the bacterial burden that causes vaginal infections, their use is debatable due to adverse effects, recurrences, antibiotic resistance and lack of selectivity, since antibiotics also reduce or eliminate beneficial bacteria. Up to 10-15% of patients undergoing administration of metronidazole or clindamycin fail to respond to initial antimicrobial therapy (Kim and Park, 2017). Additionally, BV recurrence rates among patients who showed an initial response to antibiotic therapy also remain high, reaching up to 80%, necessitating repeated administration of antibiotics.…”

“…Antibiotic treatment often fails to fully eradicate the BV pathogenic biofilm. Consequently, there is a high rate of inefficiency in antibiotic treatment, probably increasing bacterial resistance and recurrence of BV (Swidsinski et al, 2005;Kim and Park, 2017).…”