Fewer uterine polyp recurrences if vaginal microbiota balanced before surgery

According to a new study, in women scheduled for endometrial polyp removal, a vaginal microbiota is well balanced before removing uterine polyps? According to a study published in the European Journal of Obstetrics and Gynecology, this may be the case. The authors, researchers at Nanning University in China, demonstrated that the presence of a vaginal dysbiosis was a major risk factor for the recurrence of polyps after surgical removal. ¹

The link between dysbiosis and recurrence results from the impact of this microbial imbalance on the vagina and uterus, two anatomical areas closely connected in terms of immunity and microecology.

Nearly 700 women enrolled

To obtain this result, the researchers collected vaginal secretion samples from 679 women aged 25 to 50 who were undergoing “hysteroscopic resection,” a procedure to remove endometrial polyps. 

After the procedure, the women were followed for two years and the researchers identified a recurrence of polyps in 105 of them.

An analysis of the secretions indicated that women who had vaginal dysbiosis before the operation were 3.3 times more likely to experience a recurrence. This was also the case for women with endometriosis.

An analysis of the microbiotes vaginauxindicated that, in women who suffered from recurrence, the density and diversity of bacteria, as well as the presence of Lactobacilli, were significantly lower than in those with no recurrence. There were also more pathogenic microorganisms, such as the bacterium Gardnerella vaginalis and the fungus Candida, which cause vaginosis and yeast infections, respectively.

The researchers also observed increased activity of certain enzymes, such as leukocyte esterase, a sign of persistent inflammation in the vagina, which can promote infection spreading upward to the uterus.

Decline in Lactobacillus, a key factor in recurrence

How are these abnormalities in the vaginal microbiota involved in the recurrence of polyps? The researchers believe the answer lies with Lactobacillus.

Under normal circumstances, these bacteria produce bacteriocins, substances capable of destroying pathogens, as well as lactic acid, which acidifies the vaginal environment and stabilizes microbiota. They also synthesize molecules called glycerophospholipids, which in turn promote secretion by the body of anti-inflammatory messengers called prostaglandins. Lastly, they increase the synthesis of proteins that are involved in the integrity of the vaginal wall.

Thus, by reducing the risk of infection and inflammation after surgery, Lactobacillus may help protect against polyp recurrence.

This beneficial action is all the more important in women with a history of chronic microbial imbalances or endometriosis, for whom the risk of recurrence is significantly higher.

Towards preventive treatments

The researchers highlight the importance of maintaining the balance of the vaginal microbiota, particularly the long-term dominance of Lactobacillus, in cases of uterine polyps. They suggest several possible preventive treatments:

• a combination of probiotiques and antimicrobials, which would make it possible to tackle immediate pathogenic imbalances while promoting long-term microbial health;
• lactic acid-based gels or vaginal suppositories;
• bacteriophages, viruses capable of selectively destroying pathogenic bacteria without disrupting the microbiota;
• prebiotics and omega-3 fatty acids, which promote balanced microbiota.

These modulation strategies could also improve overall vaginal health by reducing the risk of persistent infection.

While studies are still needed to evaluate the effectiveness of these interventions, these avenues are promising. Keep informed!