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).