The correlation of vaginal flora and anxiety in perimenopause women: a prospective study

Perimenopausal women experience significant mental changes that affect their health and lives. Emerging evidence suggests that alterations in the vaginal microbiota may be associated with mental health symptoms through a potential vagina-brain axis. Here, we aimed to investigate the relation between anxiety in perimenopausal women and the changes in vaginal flora and identify the related factors of anxiety.

A total of 120 perimenopausal women were included. Anxiety was diagnosed using a self-rating anxiety scale. Their sleep and life quality were evaluated using the Pittsburgh Sleep Quality Index and the World Health Organization Quality of Life BREF, respectively. Then, the vaginal flora of each participant was evaluated by an oil immersion lens and a bacterial vaginosis combine-test kit. The univariate logistic regression and Pearson's correlation coefficient were used for statistical analysis.

The results showed that 52 of the 120 participants were diagnosed with anxiety. Of these, 43 anxious participants had abnormal microbiome density and diversity, while all of the anxious participants had imbalanced vaginal microecology assessment and negative hydrogen peroxide. Leukocyte esterase (LE) and sialidase (SNA) activities were higher in anxious women than that in non-anxious women. The sleep and life quality were poor in anxious participants. The pH value, LE, SNA, and sleep score were positively related to anxiety, while flora density, diversity, H₂O₂ and life quality score were negatively related to anxiety, which were protective factors.

Vaginal flora disorder is positively correlated with anxiety in perimenopausal women. These findings suggest that monitoring and modulating vaginal microbiota may help early identify or manage anxiety in perimenopausal women.