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Signs\/symptoms associated with GSM may occur during any reproductive stage from multiple etiologies but are most common during menopause due to low estrogen. Vaginal microbiota, particularly Lactobacillus spp., are beneficial to the female genital tract; however, their abundance declines during menopause. We aimed to longitudinally assess vaginal microbiota characterized by 16S rRNA gene amplicon sequencing and GSM-associated endpoints across reproductive stages. In a 2-year cohort study of 750 women aged 35\u201360 years at enrollment and 2 111 semiannual person-visits, low-Lactobacillus vaginal microbiota communities were observed at 21.2% (169\/798), 22.9% (137\/597), and 49.7% (356\/716) of person-visits among pre-, peri-, and postmenopausal women, respectively (p &amp;lt; .001). Compared to communities that have high Gardnerella vaginalis relative abundance and diverse anaerobes, the following communities were associated with a lower covariate-adjusted odds of vaginal atrophy: L crispatus-dominated communities among postmenopausal women (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.08, 0.81), L gasseri\/L jensenii (OR = 0.21; 95% CI: 0.05, 0.94) and L iners (OR = 0.21; 95% CI: 0.05, 0.85) among perimenopausal women, and L iners-dominated communities (OR = 0.18; 95% CI: 0.04, 0.76) among premenopausal women. Postmenopausal women with L gasseri\/L jensenii-dominated communities had the lowest odds of vaginal dryness (OR = 0.36; 95% CI: 0.12, 1.06) and low libido (OR = 0.28; 95% CI: 0.10, 0.74). Findings for urinary incontinence were inconsistent. Associations of vaginal microbiota with GSM signs\/symptoms are most evident after menopause, suggesting an avenue for treatment and prevention.<\/jats:p>","DOI":"10.1093\/gerona\/glab120","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T06:18:50Z","timestamp":1619504330000},"page":"1542-1550","source":"Crossref","is-referenced-by-count":63,"title":["Association of Vaginal Microbiota With Signs and Symptoms of the Genitourinary Syndrome of Menopause Across Reproductive Stages"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5283-2082","authenticated-orcid":false,"given":"Michelle","family":"Shardell","sequence":"first","affiliation":[{"name":"Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA"},{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3007-3425","authenticated-orcid":false,"given":"Patti E","family":"Gravitt","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2114-0910","authenticated-orcid":false,"given":"Anne E","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA"},{"name":"Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0851-2233","authenticated-orcid":false,"given":"Jacques","family":"Ravel","sequence":"additional","affiliation":[{"name":"Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA"},{"name":"Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8762-6214","authenticated-orcid":false,"given":"Rebecca M","family":"Brotman","sequence":"additional","affiliation":[{"name":"Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA"},{"name":"Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,27]]},"reference":[{"key":"2021081309121360200_CIT0001","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","article-title":"Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women\u2019s Sexual Health and the North American Menopause Society","volume":"21","author":"Portman","year":"2014","journal-title":"Menopause."},{"key":"2021081309121360200_CIT0002","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/GME.0000000000001609","article-title":"The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society","volume":"27","author":"The North American Menopause Society.","year":"2020","journal-title":"Menopause"},{"key":"2021081309121360200_CIT0003","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1093\/infdis\/jiz412","article-title":"Personal and clinical vaginal lubricants: impact on local vaginal microenvironment and implications for epithelial cell host response and barrier function","volume":"220","author":"Wilkinson","year":"2019","journal-title":"J Infect Dis."},{"key":"2021081309121360200_CIT0004","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/OLQ.0000000000001272","article-title":"Clinical and personal lubricants impact the growth of vaginal Lactobacillus species and colonization of vaginal epithelial cells: an in vitro study","volume":"48","author":"\u0141aniewski","year":"2021","journal-title":"Sex Transm Dis."},{"key":"2021081309121360200_CIT0005","doi-asserted-by":"crossref","first-page":"7625","DOI":"10.1038\/s41598-020-63652-x","article-title":"Effect of commercial vaginal products on the growth of uropathogenic and commensal vaginal bacteria","volume":"10","author":"Hung","year":"2020","journal-title":"Sci. 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