Brotman RM, et al. – Via analyzing 87 women (aged 35-60 years), researchers delineated the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women, and examined the link between the microbiota and vulvovaginal atrophy (VVA). They identified clustering of bacterial communities into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii. Two (CST IV-A [characterized by Streptococcus and Prevotella] and CST IV-B [characterized by Atopobium]) had low relative abundance of Lactobacillus. Perimenopausal women displayed a higher tendency to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were frequently classified as CST IV-A. Premenopausal women displayed a higher prevalence of CSTs dominated by L. crispatus and L. iners. The vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A vs L. crispatus CST vs those of women with no VVA.