Microbiome profiles were associated with hormone therapy responses in perimenopausal women

Researchers in China enrolled 356 women aged 40–55 years with menopausal symptoms at 14 centers. All received daily oral estradiol/dydrogesterone for six months; assessments took place at baseline and weeks 4, 12 and 24. Shotgun metagenomic sequencing was performed on samples from the tongue, stool, vaginocervical secretions and urine. There was no untreated comparison group. A total of 295 participants completed the week-24 visit.

Symptoms improved during treatment: median modified Kupperman Index scores fell by 63.0% and Female Sexual Function Index scores rose by 13.6% at week 24. The researchers reported the most pronounced microbial changes in vaginocervical and urinary samples, with more modest changes in oral samples and minimal changes in stool. Baseline vaginocervical Lactobacillus crispatus levels and community types were associated with subsequent microbial and symptom outcomes. Gut community type was also associated with hormonal responsiveness and clinical outcomes.

The findings suggest that baseline microbiome profiles may help explain variation in response, but they do not establish that microbiome testing can guide treatment or improve outcomes. All participants received therapy, and the reported associations do not establish that microbial changes caused symptom improvement. The study’s authors note that generalizability may be limited; the work was conducted in China.