Investigating the effects of probiotics during the menopause transition: A systematic review & meta-analysis

This review investigated the impact of probiotics during the menopause transition and explored their potential to enhance the effectiveness of estrogenic substances in perimenopausal or recently postmenopausal women. A thorough literature search of EMBASE, MEDLINE, Cochrane Library, Scopus, and Web of Science was conducted, identifying 39 studies involving 3187 women. Quality assessments were conducted using the relevant Cochrane Risk of Bias tools. The results demonstrated that probiotics had positive effects on menopausal symptoms, urogenital health, bone health, and the efficacy and safety of estriol and isoflavones. Meta analysis of 7 studies comparing probiotics versus placebo demonstrated large effects of probiotics on menopausal symptoms (total score) [standardized mean difference (SMD) = 0.82, 95 % CI -0.52 to -1.09], vasomotor symptoms (SMD = -0.96, 95 % CI -1.25 to -0.68), psychological symptoms (SMD = -0.51, 95 % CI -0.95 to -0.08), vaginal dryness (SMD = 0.95, 95 % CI -1.40 to -0.49), and vaginal microbiome health (Nugent score) (SMD = -0.91, 95 % CI -1.32 to -0.49). Meta-analysis results were nonsignificant for reducing somatic and sexual symptoms. Probiotics hold promise in addressing symptoms related to low estrogen levels and may enhance the effects of estriol and isoflavones, offering potential benefits as part of the management of menopausal women. It's important to note that the included studies had a high risk of bias, emphasising the need for further rigorous research in this area. Should findings continue to show promise, clinicians should consider incorporating probiotics into their strategies for managing menopausal symptoms. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42019146270.