Results
Two hundred medical records of women with POI were reviewed, and 85, who
met the inclusion criteria according to the medical record, were
selected. After the interviews, 30 women were excluded due to incorrect
adherence to HT; HT used for less than 6 months or absence of sexual
activity at the time (criterion for inclusion in the main study). The
other women were then invited to participate in the study. Fifteen women
refused to participate. Forty women were then examined and samples of
vaginal secretion were collected. At the time of pyrosequencing, seven
samples were excluded because of insufficient amount of genetic material
resulting from DNA extraction (Figure 1).
The mean age of the participants was 37.13 (± 7.27) years, with a
diagnosis of POI at 27.90 (± 8.68) years. The time elapsed between the
date of diagnosis and the inclusion in the study was 9.23 (± 8.45)
years, duration of treatment with systemic hormonal therapy was 8.20 (±
8.73) years (Table 1). Out of the total number of women, 77.5% were
using oral conjugated estrogen (EE) or 17 beta estradiol (E2) associated
with a progestogen (medroxyprogesterone acetate or norethisterone
acetate), 15% used combined oral contraceptives, and 7.5% tibolone, as
a systemic hormonal therapy. Fifty-seven percent were nulliparous and
42.5% had 1 or more children.
The results obtained from the
vaginal secretion samples and analyzed for microbiome description
(taxonomic plot for distribution of bacteria for each subject is
presented in Figure 2) showed
that 33.4% (N = 11) of the women with POI and using HT had a group I
compatible vaginal microbiome, with a predominance of L.
crispatus ; 9% (N = 3) of the women had a group II flora microbiome
with a predominance of L. gasseri ; 33.4% (N = 11) of the women,
had a group III flora microbiome, with predominance of L. iners ;
15.2% (N = 5) of the women had group IV flora, with a predominance of
anaerobic bacteria; and 9% (N = 3) of the women had group V flora, with
a predominance of L. jensenii (Graph 1).