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Pre\u2010menopausal gynaecologic surgery was significantly associated with faecal microbiota beta diversity driven by a relative increase in diabetogenic\n                      <jats:italic>Ruminococcus gnavus<\/jats:italic>\n                      and\n                      <jats:italic>Clostridium<\/jats:italic>\n                      species and a decrease in protective\n                      <jats:italic>Alistipes<\/jats:italic>\n                      species and\n                      <jats:italic>Akkermansia muciniphila<\/jats:italic>\n                      relative abundances. A reduction in two glycerophospholipids in the plasmalogen class significantly statistically mediated an inverse association between gynaecologic surgery before menopause and insulin sensitivity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Menopause age and history of HRT are more strongly associated with insulin resistance than gynaecologic surgery before menopause. However, gynaecologic surgery is associated with shifts in gut microbial composition and plasma metabolite levels with a potential to contribute to future diabetes risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16578","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:08:10Z","timestamp":1753866490000},"page":"5444-5454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Menopause factors and alterations in gut microbiota and insulin homeostasis: A cross\u2010sectional analysis of the microbiome and insulin longitudinal evaluation study (\n                    <scp>MILES<\/scp>\n                    )"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5339-5945","authenticated-orcid":false,"given":"Vincent J.","family":"Maffei","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine  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