LAUSR

Key Points Question What are the effects of estradiol or vaginal moisturizer on the vaginal microbiota, metabolome, and pH after 12-week treatment in postmenopausal women? Findings In this secondary analysis of 144 participants in a randomized clinical trial of postmenopausal women with moderate to severe vulvovaginal symptoms, women using vaginal 10 μg estradiol tablet demonstrated larger changes in the vaginal microbiota and metabolome compared with women using vaginal moisturizer or placebo, despite a decrease in pH within each intervention group. Meaning These findings suggest that treatment of genitourinary symptoms of menopause with topical estradiol changes the vaginal microenvironment in ways that may promote genitourinary health.