Effect of Lactobacillus-based probiotics on genitourinary syndrome of menopause in post-menopausal women: A systematic review.

BACKGROUND AND

OBJECTIVE

Genitourinary syndrome of menopause is a chronic condition caused by estrogen deficiency after menopause and includes both vaginal and urinary symptoms that significantly impair quality of life. Although local estrogen therapy is effective, non-hormonal alternatives are needed for women in whom hormonal treatment is contraindicated or unacceptable. We investigated the clinical evidence on the efficacy of Lactobacillus-based probiotic interventions for the management of genitourinary syndrome of menopause.

METHODS

In January 2026, PubMed, Scopus, and Embase were searched for studies evaluating oral or intravaginal Lactobacillus-based probiotics in women with genitourinary syndrome of menopause.

RESULTS

Nine studies with a total of 751 patients were included - five randomized controlled trials and four prospective studies. Five studies evaluated urinary outcomes, including recurrent cystitis, recurrent urinary tract infection, and lower urinary tract symptoms, while four focused on vaginal outcomes such as vaginal microbiota composition, vaginal pH, vaginal health index, and vulvar pain. Intravaginal Lactobacillus showed a preventive effect for recurrent cystitis in single-arm and prospective cohort studies, whereas randomized controlled trials demonstrated mixed or negative results compared with antibiotic prophylaxis. Evidence for improvement in lower urinary tract symptoms and vaginal manifestations of genitourinary syndrome of menopause was limited and heterogeneous, particularly in studies using oral probiotic administration.

CONCLUSION

Lactobacillus-based interventions may represent a complementary therapeutic option for selected women with genitourinary syndrome of menopause, especially for urinary manifestations associated with vaginal dysbiosis. However, current evidence is limited by heterogeneity in study design, probiotic formulations, and routes of administration. Well-designed randomized clinical trials, particularly those evaluating intravaginal Lactobacillus formulations, are required to clarify their clinical role in genitourinary syndrome of menopause management.

PROSPERO REVIEW REGISTRATION: CRD420251244350.