The Impact of Local Estrogen on the Urogenital Microbiome in Genitourinary Syndrome of Menopause: A Randomized-Controlled Trial

Jennifer Nicole Lillemon, Lisa Karstens, Rahel Nardos, Bharti Garg, Emily R. Boniface, W. Thomas Gregory

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Importance The postmenopausal urinary bladder microbiome is not well defined. Objectives The aims of this study were to characterize the effect of vaginal estrogen on the vaginal and urinary bladder microbiome in postmenopausal women and describe any clinical associations with the symptoms of genitourinary syndrome of menopause. Study Design This was a participant-masked, randomized controlled trial comparing the effect of a 12-week course of an estrogen-containing vaginal ring to a placebo vaginal ring. Standardized evaluations were performed at baseline and 12 weeks. Vaginal samples were obtained for pH, vaginal maturation index, and microbiome analysis. Concomitant catheterized urine samples were obtained for microbiome analysis. 16S ribosomal RNA gene sequencing was performed to characterize the resident microbial communities, with Lactobacillus relative abundance as the primary outcome variable. Genitourinary syndrome of menopause symptoms was measured using validated questionnaires (Pelvic Floor Distress Inventory-Short Form, Female Sexual Function Index, Vulvovaginal Symptoms Questionnaire). Results Of the 39 postmenopausal women randomized, baseline characteristics were similar between arms, with a mean age of 62 years and mean vaginal pH of 5.0. Using intention-to-treat analysis, there were no significant changes in vaginal or urinary Lactobacillus relative abundance. Two participants in each arm removed their ring prior to the end of the study. Eighty percent of participants experienced at least 1 bothersome genitourinary syndrome of menopause symptom. Vulvovaginal dryness and urinary frequency were most common at baseline, whereas painful intercourse and urinary urgency were most common at the final visit, none of which were statistically significant. Conclusions Our study did not show a significant change in the bacterial composition of the vaginal or urinary bladder microbiome after either vaginal ring in this relatively asymptomatic postmenopausal population.

Original languageEnglish (US)
Pages (from-to)E157-E162
JournalFemale Pelvic Medicine and Reconstructive Surgery
Issue number6
StatePublished - Jun 1 2022

Bibliographical note

Funding Information:
Funding was made possible through the Collins Medical Trust (GOBGY0360A). Coinvestigator L.K. was additionally supported by the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (K01 DK116706). The contents of the article are solely our responsibility and do not represent the official views of the National Institutes of Health or of any other funding agency.

Publisher Copyright:
© American Urogynecologic Society. All rights reserved.


  • genitourinary syndrome of menopause
  • urinary bladder microbiome
  • urogenital microbiome
  • vaginal estrogen
  • vaginal microbiome

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial


Dive into the research topics of 'The Impact of Local Estrogen on the Urogenital Microbiome in Genitourinary Syndrome of Menopause: A Randomized-Controlled Trial'. Together they form a unique fingerprint.

Cite this