# Multi-site microbiota crosstalk in the postmenopausal: from dysbiosis mechanisms to precision interventions

## TL;DR

This paper explores how changes in the gut, vaginal, and urinary microbiota due to low estrogen in postmenopause contribute to health issues and suggests new ways to treat them.

## Contribution

The paper introduces a new framework called 'Postmenopausal Microbiota Network Medicine' to address root causes of postmenopausal health issues.

## Key findings

- Estrogen deficiency reshapes gut–vaginal–urinary ecosystems, leading to multisystem dysfunction.
- Microbial cross-talk links gut toxins to vascular inflammation and vaginal dysbiosis to urinary infections.
- Bile acid disruption from microbiota changes affects bone and immune health.

## Abstract

Persistent estrogen deficiency in postmenopause reshapes the gut–vaginal–urinary ecosystems, contributing to multisystem dysfunction through interconnected dysbiosis. Cross-niche microbial interactions amplify systemic risks: gut-derived toxins are linked to vascular inflammation, vaginal dysbiosis facilitates urinary pathogen colonization, and bile acid disruption impairs bone–immune homeostasis. This review synthesizes current mechanistic evidence illustrating how microbial networks propagate postmenopausal comorbidities. We propose the framework of “Postmenopausal Microbiota Network Medicine” which integrates microbial dynamics with host omics to transition from symptomatic management toward root-cause interception by strengthening microbial network resilience.