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The United Nations has declared 2021–2030 as the “Decade of Healthy Aging,” emphasizing the need for gender-specific strategies to support women’s health as they age. This initiative is crucial, as the number of postmenopausal women is increasing, and many remain active both professionally and socially. A recent review by researchers from the University of Seville, Spain, explored the menopausal transition, its effects on the microbiome, and the hormonal changes women face during menopause.
Menopause and Its Impact on the Microbiome
Menopause, defined as the cessation of menstruation after 12 consecutive months without a menstrual cycle, typically occurs around the age of 52. This natural process happens when the ovaries run out of functional follicles. This leads to a decline in the key female hormones—estrogen and progesterone. These hormonal changes can trigger various symptoms, such as hot flashes, mood swings, and an increased risk of cardiovascular and bone diseases.
The drop in estrogen levels during menopause significantly affects the body’s microbiome—a community of microorganisms inhabiting areas such as the gut, vagina, skin, and oral cavity. These hormonal shifts can disrupt microbial balance, a condition known as dysbiosis, which may lead to health issues. For instance, decreased estrogen levels can alter saliva production, increasing the risk of infections. A comprehensive approach targeting both microbial balance and hormonal regulation is essential.
Global Trends in Hormone Therapy
Hormone replacement therapy (HRT) is a common treatment for alleviating menopause symptoms by restoring hormone levels. In 2023, the global HRT market was valued at approximately $20.91 billion and is projected to reach $35.86 billion by 2032.
However, the use of HRT varies. In the United States, its prevalence declined from 26.9% in 1999 to 4.7% in 2020 due to changing perceptions of health risks. Meanwhile, a large-scale 2024 study involving over 10 million women demonstrated that appropriate hormone therapy remains safe, even after the age of 65.
Hormones and the Microbiome
Estrogen plays a vital role throughout a woman’s life—from puberty and pregnancy to menopause. As women age, microbiome diversity decreases, influenced by lifestyle, hormone levels, and immune responses. The thinning and drying of mucosal linings during menopause can lead to imbalances in vaginal and oral bacteria, which HRT can help mitigate. Estrogen and the microbiome interact dynamically, with bacteria capable of activating stored estrogen, affecting estrogen-dependent processes.
Decreased estrogen levels during menopause may cause oral tissue inflammation and microbial imbalance. Certain oral bacteria can metabolize steroid hormones, potentially leading to oral dysbiosis. While research highlights the influence of estrogen and progesterone on oral bacteria, the precise mechanisms require further study.
Beyond the oral cavity, menopause also impacts the gut and urogenital microbiomes. In the vaginal microbiome, beneficial Lactobacillus species decline, increasing susceptibility to infections. This phenomenon is part of the broader “menopause paradox,” where microbial diversity rises, but beneficial microbes diminish.
Personalized Solutions for Healthier Aging
Understanding the interplay between hormonal changes and the microbiome is key to developing personalized approaches. Tailored dietary supplements and healthy lifestyle practices can help restore microbial balance, potentially easing menopause symptoms and promoting healthy aging. Integrating microbiome-focused strategies with traditional treatments, including HRT, offers holistic solutions for women undergoing the menopausal transition.
Menopause induces hormonal shifts that alter the female microbiome and influence health risks. Recognizing these changes and adopting personalized approaches are critical steps toward improving women’s health during this life stage.
Effectively addressing menopause symptoms also has significant economic benefits. Improved diagnosis and treatment could add approximately $120 billion annually to the global gross domestic product (GDP), underscoring the importance of accessible and effective menopause care.
