Before menopause, there is a transition period called perimenopause, which can last about four years until the ovaries stop functioning and menstruation stops completely. During these years, estrogen levels decrease and women have to deal with symptoms such as hot flashes, vaginal dryness, sleep problems and more. For some it can be debilitating, but for others the symptoms are much less intense. The difference may be due to the microbiome. The microbiome is a set of bacteria that live inside us and protect us from pathogens, synthesize vitamins, help regulate the immune system and digestion. Some of these microorganisms have the ability to regulate the levels of estrogens that circulate in the body. These bacteria synthesize an enzyme called beta-glucuronidase, which in the intestine transforms estrogen into its active form. With this transformation, the bacteria alter blood estrogen levels, creating a link between the gut microbiome, vaginal microbiome, and estrogen levels in the body. Estrogen deficiency leads to bone loss and easier weight gain. High estrogen levels also pose risks because they worsen endometriosis and increase the risk of breast, ovarian, and cervical cancer. Depending on the state of our microbiome, estrogens will be activated to a greater or lesser extent. If the microbiome is balanced, it will help the estrogens to activate to the right degree. And this is even more important in the transition to menopause, when estrogen begins to decline. What is the impact on the vaginal microbiome? The microbiome changes throughout a woman’s life because hormone levels will determine which bacteria will predominate. The microbiome is different depending on age. During menopause, there is a decrease in estrogen levels and this leads to a decrease in bacterial diversity in the microbiome. Reduced bacterial diversity and lower estrogen levels affect the vaginal microbiome, causing vaginal atrophy and less cervical mucus. These changes create an unfavorable environment in the vagina: the pH changes and this leads to the loss of even more vaginal flora. This is why vaginal dryness and infections become more common during menopause. If in the transition years to menopause we maintain a healthy vaginal microbiome, estrogens, although decreasing, will remain more active and symptoms will be less. This will help reduce inflammation, urinary tract infections, hot flashes, atrophy and vaginal dryness. How to regulate the microbiome? Probiotics are very useful for regulating the vaginal microbiome at this stage of a woman’s life. Those containing different strains of Lactobacillus are recommended, as these are key bacteria in the vaginal flora and are among the most depleted during menopause. There is scientific evidencethat Lactobacillus probiotics help maintain estrogen balance and prevent bone loss. Fermented foods like kefir and kombucha are probiotics that help us get good bacteria in our gut. In addition to taking probiotics, it is very important to follow a varied diet rich in fresh vegetables, which are a source of prebiotics that feed the good bacteria. Sources: https://www.sabervivirtv.com/ginecologia/cuidar-microbiota-reduce-sintomas-menopausia_6447