Heterogeneity of microbiome responses to menopausal hormone therapy among perimenopausal women.

Oral estradiol/dydrogesterone for 6 months in 356 perimenopausal women reshaped vaginocervical and urinary microbiomes, with baseline vaginocervical Lactobacillus crispatus linked to stronger symptom and colonization outcomes.

• Why it matters: MHT helps climacteric symptoms, but microbiome-wide effects and which baseline microbial states predict better efficacy are unclear, limiting personalized treatment.
• What they did: In a 6-month oral MHT study of 356 perimenopausal women, researchers assessed site-specific microbial remodeling and tested how baseline vaginocervical and gut community types related to postintervention colonization and clinical measures, including 4-week rapid clinical remission.
• The result: MHT increased vaginocervical L. crispatus and reduced Gardnerella vaginalis; higher baseline L. crispatus predicted greater postintervention vaginocervical and urinary colonization and better Female Sexual Function Index improvement, while Phocaeicola vulgatus-dominated gut communities showed greater responsiveness and higher likelihood of 4-week rapid clinical remission than Prevotella copri-dominated women.

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