Volume 8 Number 1 2025
Probiotics as a Therapeutic Modulator of Menstrual Health: A Systematic Review of Microbiota–Hormone Interactions
Md Fakruddin 1*, Moftiful Islam 1, Mahi Rubayia Islam 1, Nur E Ahad 1, Khalid Hossain Zihad 1, Nishat Islam Borni 1, Jahanara Abdul Hannan 1, Rashfinur Yesmen 1, Aysha Sultana 1
Microbial Bioactives 8 (1) 1-8 https://doi.org/10.25163/microbbioacts.8110423
Submitted: 17 August 2025 Revised: 03 October 2025 Accepted: 12 October 2025 Published: 15 October 2025
Abstract
Menstrual health conditions such as dysmenorrhea, premenstrual syndrome (PMS), polycystic ovary syndrome (PCOS), and bacterial vaginosis (BV) represent major challenges to women’s well-being, often affecting both physical and emotional health. While conventional treatments can provide relief, their side effects and inconsistent long-term outcomes have encouraged exploration of safer, more holistic alternatives. This systematic review synthesizes evidence from fifteen peer-reviewed studies published between 2018 and 2025 that evaluated the therapeutic potential of probiotics in menstrual health management. The studies examined diverse probiotic strains and mechanisms involving gut–vaginal microbiota regulation, hormone modulation, and anti-inflammatory responses. Results demonstrate that Lactobacillus crispatus, L. rhamnosus, and L. reuteri effectively restore vaginal pH, reduce bacterial vaginosis recurrence, and alleviate PMS-related symptoms such as mood swings, bloating, and fatigue. In women with PCOS, probiotics were linked to improved insulin sensitivity, decreased androgen levels, and enhanced menstrual regularity. Additionally, probiotic supplementation reduced inflammatory markers and contributed to balanced estrogen metabolism through estrobolome activity. Despite these promising outcomes, variations in strain selection, dosage, and treatment duration across studies hinder universal recommendations. The review highlights probiotics as a non-invasive, microbiome-based approach that supports menstrual health through hormonal, metabolic, and microbial pathways. Future large-scale, standardized clinical trials are essential to define optimal therapeutic formulations and establish long-term efficacy.
Keywords: Probiotics, Menstrual Health, Polycystic Ovary Syndrome, Premenstrual Syndrome, Microbiota Modulation
References
Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45-53.
Basnet, J., Eissa, M. A., Yanes-Cardozo, L. L., Romero, D. G., & Rezq, S. (2024). Impact of probiotics and prebiotics on gut microbiome and hormonal regulation. Gastrointestinal Disorders, 6(4), 801–815. https://doi.org/10.3390/gidisord6040056
Chieng, H. Y., Abdul Jalal, M. F., Bedi, G., Zakariauddin, Z. M., Mokhtar, N. A., Abu, M. A., Chew, K. T., & Nur Azurah, A. G. (2022). Probiotics, a promising therapy to reduce the recurrence of bacterial vaginosis in women? A systematic review and meta-analysis of randomized clinical trials. Frontiers in Cellular and Infection Microbiology, 12, 943626. https://doi.org/10.3389/fcimb.2022.943626
Davis, J., & Westwood, M. (2017). The impact of premenstrual syndrome on women's lives. Women’s Health Journal, 24(2), 125-130.
De Gregorio, P. R., Juárez Tomás, M. S., Leccese Terraf, M. C., & Nader-Macías, M. E. F. (2014). In vitro and in vivo effects of beneficial vaginal lactobacilli on pathogens responsible for urogenital tract infections.
Deluca, G., Bernacchi, G., & Martinelli, M. (2016). Gut dysbiosis and reproductive health: Emerging evidence. Journal of Reproductive Medicine, 61(3), 210-217.
Foster, J. A., Rinaman, L., & Cryan, J. F. (2016). Stress and the gut–brain axis: Regulation by the microbiome. Neurobiology of Stress, 7, 124–136. https://doi.org/10.1016/j.ynstr.2016.03.001
Foster, J. W., McVey, N., & Novak, R. (2016). Gut microbiota and reproductive health: A review of current evidence. Journal of Women's Health, 25(4), 345-357.
Gómez, A., Espinosa, T., & Carvajal, B. (2015). Natural approaches to managing menstrual disorders: A review. Integrative Medicine Reports, 14(1), 78-85.
Hashem, N. M., & Gonzalez-Bulnes, A. (2022). The use of probiotics for management and improvement of reproductive eubiosis and function. Nutrients, 14(4), 902. https://doi.org/10.3390/nu14040902
Ji, X., Chen, J., Xu, P., Shen, S., & Bi, Y. (2022). Effect of probiotics combined with metformin on improvement of menstrual and metabolic patterns in women with polycystic ovary syndrome: a randomized clinical trial. Gynecological Endocrinology, 38(10), 856-860.
Miller, C. L., Adams, M. M., & Thompson, J. R. (2016). Microbiome and menstrual health: The role of probiotics. Current Women’s Health Reports, 12(3), 221-230.
Pérez, R., Simón, M., & Rodríguez, C. (2015). Probiotic modulation of inflammation in menstrual disorders. Nutrition & Health, 31(2), 154-162.
Petrova, M. I., Lievens, E., Malik, S., Imholz, N., & Lebeer, S. (2015). Lactobacillus species as biomarkers and therapies for vaginal health. Frontiers in Microbiology, 6, 756.
Petrova, M. I., van den Broek, M., Balzarini, J., Vanderleyden, J., & Lebeer, S. (2015). Vaginal microbiota and its role in the protection against infections. BioMed Research International, 2015, 1–14. https://doi.org/10.1155/2015/85454
Reid, G. (2001). Probiotic agents to protect the urogenital tract against infection. The American Journal of Clinical Nutrition, 73(2), 437S-443S.
Reid, G., & Bocking, A. (2003). The potential for probiotics to prevent bacterial vaginosis and preterm labor. American Journal of Obstetrics and Gynecology, 189(4), 1202-1208.
Reid, G., & Bruce, A. W. (2006). Probiotics to prevent urinary tract infections: the rationale and evidence. World Journal of Urology, 24(1), 28-32.
Reid, G., & Burton, J. (2002). Use of Lactobacillus to prevent infection by pathogenic bacteria. Microbes and Infection, 4(3), 319-324.
Reid, G., & Hammond, J. A. (2005). Probiotics: role in urogenital health. Annals of Medicine, 37(3), 218-225.
Reid, G., Charbonneau, D., Erb, J., Kochanowski, B., Beuerman, D., Poehner, R., & Bruce, A. W. (2003). Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunology & Medical Microbiology, 35(2), 131-134.
Reid, G., Dols, J., & Miller, W. (2009). Targeting the vaginal microbiota with probiotics as a means to counteract infections. Current Opinion in Clinical Nutrition & Metabolic Care, 12(6), 583-587.
Sanders, M. E., Akkermans, L. M., Haller, D., Hammerman, C., Heimbach, J. T., Hörmannsperger, G., & Huys, G. (2010). Safety assessment of probiotics for human use. Gut microbes, 1(3), 164-185.
Martinez Guevara, D., Vidal Cañas, S., Palacios, I., Gómez, A., Estrada, M., Gallego, J., & Liscano, Y. (2024). Effectiveness of probiotics, prebiotics, and synbiotics in managing insulin resistance and hormonal imbalance in women with polycystic ovary syndrome (PCOS): A systematic review of randomized clinical trials. Nutrients, 16(22), 3916.
Zakaria, I. A., Mohammed Zakaria, N. A., Teik, C. K., Abu, M. A., Zakariauddin, A. A., Abdul Aziz, N. H., ... & Nur Azurah, A. G. (2024). The role of probiotics in improving menstrual health in women with primary dysmenorrhoea: A randomized, double-blind, placebo-controlled trial (the PERIOD study). Women's Health, 20, 17455057241234524.
Li, P., Shuai, P., Shen, S., Zheng, H., Sun, P., Zhang, R., ... & Wan, Z. (2023). Perturbations in gut microbiota composition in patients with polycystic ovary syndrome: a systematic review and meta-analysis. BMC medicine, 21(1), 302.