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Division of Biological Sciences, University of California San Diego, La Jolla, California, USA
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Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
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Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA
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Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, California, USA
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Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
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Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
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Medical Scientist Training Program, University of California San Diego, La Jolla, California, USA
Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA
Institute of Diabetes and Metabolic Health, University of California San Diego, La Jolla, California, USA
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Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
Department of Computer Science and Engineering, University of California, San Diego, La Jolla, California, USA
Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, California, USA
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Graphical abstract
Abstract
Although numerous studies have demonstrated the impact of microbiome manipulation on human health, research on the microbiome’s influence on female health remains relatively limited despite substantial disease burden. In light of this, we present a selected review of clinical trials and preclinical studies targeting both the vaginal and gut microbiomes for the prevention or treatment of various gynecologic conditions. Specifically, we explore studies that leverage microbiota transplants, probiotics, prebiotics, diet modifications, and engineered microbial strains. A healthy vaginal microbiome for females of reproductive age consists of lactic acid-producing bacteria predominantly of the Lactobacillus genus, which serves as a protective barrier against pathogens and maintains a balanced ecosystem. The gut microbiota’s production of short-chain fatty acids, metabolism of primary bile acids, and modulation of sex steroid levels have significant implications for the interplay between host and microbes throughout the body, ultimately impacting reproductive health. By harnessing interventions that modulate both the vaginal and gut microbiomes, it becomes possible to not only maintain homeostasis but also mitigate pathological conditions. While the field is still working toward making broad clinical recommendations, the current studies demonstrate that manipulating the microbiome holds great potential for addressing diverse gynecologic conditions.
Lay summary
Manipulating the microbiome has recently entered popular culture, with various diets thought to aid the microbes that live within us. These microbes live in different locations of our body and accordingly help us digest food, modulate our immune system, and influence reproductive health. The role of the microbes living in and influencing the female reproductive tract remains understudied despite known roles in common conditions such as vulvovaginal candidiasis (affecting 75% of females in their lifetime), bacterial vaginosis (25% of females in their lifetime), cervical HPV infection (80% of females in their lifetime), endometriosis (6–10% of females of reproductive age), and polycystic ovary syndrome (10–12% of females of reproductive age). Here, we review four different approaches used to manipulate the female reproductive tract and gastrointestinal system microbiomes: microbiota transplants, probiotics, prebiotics, and dietary interventions, and the use of engineered microbial strains. In doing so, we aim to stimulate discussion on new ways to understand and treat female reproductive health conditions.
