PROBIOTICS IN THE PREVENTION AND TREATMENT OF UROGENITAL INFECTIONS IN POSTMENOPAUSAL WOMEN: A SYSTEMATIC REVIEW

Zuzanna Banas; Paulina Kisielewska; Weronika Dmoch; Julia Sawicka; Szymon Chmiela; Kinga Dzioba; Julia Dzięcioł; Gabriela Kamińska; Natalia Bołtralik

doi:10.31435/ijitss.2(50).2026.5506

Authors

Zuzanna Banas Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0003-9156-0221
Paulina Kisielewska Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0007-2028-1494
Weronika Dmoch Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0004-2652-8011
Julia Sawicka Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0004-0724-7839
Szymon Chmiela Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0008-2901-615X
Kinga Dzioba Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0002-4549-8810
Julia Dzięcioł Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0000-1394-2951
Gabriela Kamińska Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0005-9454-8927
Natalia Bołtralik Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0006-1207-7752

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5506

Keywords:

Probiotics; Urogenital Infections; Postmenopausal Women; Vaginal Microbiota

Abstract

Background. Postmenopausal women are prone to recurrent urinary and vaginal infections due to estrogen decline, epithelial atrophy, elevated pH, and loss of Lactobacillus-dominated microbiota. Antibiotics reduce recurrences but promote resistance. Probiotics may restore vaginal homeostasis, inhibit pathogens, and modulate immunity.

Aim. To review randomized controlled trials (RCTs) on probiotics for prevention and treatment of urogenital infections in postmenopausal women.

Materials and methods. PubMed, Scopus, and Web of Science were searched to, in line with PRISMA. Eligible RCTs investigated probiotic interventions reporting clinical or microbiological outcomes. Risk of bias was assessed with the Cochrane RoB 2.0 tool. Results were synthesized narratively due to heterogeneity.

Results. Six RCTs were included. Vaginally derived strains such as L. rhamnosus GR-1, L. reuteri RC-14, L. crispatus, L. gasseri, and L. jensenii improved Nugent scores and vaginal microbiota. Oral GR-1/RC-14 achieved meaningful changes even after short treatment, whereas L. rhamnosus GG was ineffective due to poor colonization. Large-scale trials showed probiotics less effective than antibiotics for UTI prevention but without inducing resistance. All regimens were well tolerated, with no serious adverse events.

Conclusion. Probiotics are safe and may improve vaginal microbiota in postmenopausal women. Efficacy is strain- and route-dependent, with GR-1/RC-14 showing the most consistent results. While not a replacement for antibiotics, probiotics represent a promising adjunct in non-hormonal management of urogenital health. Further high-quality trials are needed to establish optimal use.

References

Andrews, R. A. F., Locey, A., et al. (2025). Investigating the effects of probiotics during the menopause transition: A systematic review & meta-analysis. Clinical Nutrition ESPEN, 69, 241–256.

Beerepoot, M. A. J., ter Riet, G., Nys, S., van der Wal, W. M., de Borgie, C. A. J. M., de Reijke, T. M., Prins, J. M., Koeijers, J., Verbon, A., Stobberingh, E., & Geerlings, S. E. (2012). Lactobacilli vs antibiotics to prevent urinary tract infections: A randomized, double-blind, noninferiority trial in postmenopausal women. Archives of Internal Medicine, 172(9), 704–712. https://doi.org/10.1001/archinternmed.2012.777

Bisanz, J. E., Seney, S., McMillan, A., Vongsa, R., Koenig, D., Wong, L., Dvoracek, B., Gloor, G. B., Sumarah, M., Ford, B., Herman, D., Burton, J. P., & Reid, G. (2014). A systems biology approach investigating the effect of probiotics on the vaginal microbiome and host responses in a double blind, placebo-controlled clinical trial of post-menopausal women. PLoS ONE, 9(8), e104511. https://doi.org/10.1371/journal.pone.0104511

Colodner, R., Edelstein, H., Chazan, B., & Raz, R. (2003). Vaginal colonization by orally administered Lactobacillus rhamnosus GG. Israel Medical Association Journal, 5(11), 767–769.

Caretto, M., Giannini, A., Russo, E., & Simoncini, T. (2017). Preventing urinary tract infections after menopause without antibiotics. Maturitas, 99, 43–46. https://doi.org/10.1016/j.maturitas.2017.02.004

Gupta, K., & Trautner, B. W. (2013). Recurrent urinary tract infections in women. Annals of Internal Medicine, 158(7), 535–546.

Jung, C., & Brubaker, L. (2019). The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric, 22(3), 242–249. https://doi.org/10.1080/13697137.2018.1551871

Marschalek, J., Farr, A., Marschalek, M. L., et al. (2017). Influence of orally administered Lactobacillus strains on vaginal microbiota in hypoestrogenic women. Breast Care, 12(4), 239–243.

Petricevic, L., Unger, F. M., Viernstein, H., & Kiss, H. (2008). Randomized, double-blind, placebo-controlled study of oral lactobacilli to improve the vaginal flora of postmenopausal women. European Journal of Obstetrics & Gynecology and Reproductive Biology, 141(1), 54–57. https://doi.org/10.1016/j.ejogrb.2008.06.003

Portman, D. J., & Gass, M. L. S. (2014). Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy. Menopause, 21(10), 1063–1068.

Raz, R. (2011). Urinary tract infection in postmenopausal women. Korean Journal of Urology, 52(12), 801–808. https://doi.org/10.4111/kju.2011.52.12.801

Reid, G., & Burton, J. P. (2014). Use of Lactobacillus to prevent infection by pathogenic bacteria. Microbes and Infection, 16(7), 495–504.

Stapleton, A. E. (2016). The vaginal microbiota and urinary tract infection. Microbiology Spectrum, 4(6), UTI-0025-2016. https://doi.org/10.1128/microbiolspec.UTI-0025-2016

Stabile, G., Romano, F., Caruso, S., et al. (2023). The role of vaginal microbiota in the management of genitourinary syndrome of menopause. Climacteric, 26(2), 113–121.

Tomusiak, A., Heczko, P. B., Janeczko, J., et al. (2015). Efficacy and safety of a vaginal medicinal product containing three strains of probiotic bacteria: A multicenter, randomized, double-blind, placebo-controlled trial. Drug Design, Development and Therapy, 9, 5345–5354.

Vicariotto, F., Mogna, L., & Del Piano, M. (2024). Oral and vaginal probiotics in postmenopausal women: Effects on vaginal well-being and microbiota composition. Journal of Clinical Medicine, 13(3), 612.

de Vrese, M., Laue, C., Papazova, E., Petricevic, L., & Schrezenmeir, J. (2019). Impact of oral administration of four Lactobacillus strains on Nugent score—Systematic review and meta-analysis. Beneficial Microbes, 10(5), 483–496. https://doi.org/10.3920/BM2018.0129

Wagenlehner, F. M. E., Vahlensieck, W., Bauer, H. W., Weidner, W., Piechota, H. J., & Naber, K. G. (2013). Prevention of recurrent urinary tract infections. Minerva Urology and Nephrology, 65(1), 9–20.

Yoshikata, R., Shiraishi, T., Yamamoto, T., et al. (2022). Effects of Lactobacillus-containing feminine products on vaginal microbiota and genitourinary symptoms: A randomized trial. PLoS ONE, 17(12), e0278654.