Table 1_Vaginal microbiota and functional prediction along the progression of cervical lesions in postmenopausal women.xlsx

PERMANOVA showed no ASV-level beta diversity separation, with significant phylum-level divergence (R² = 0.105, p = 0.001). Lactobacillus iners dominated all samples but decreased in CC, alongside elevated opportunistic pathogens. LEfSe screened group-specific taxa: L. johnsonii (HC), Dialister pneumosintes (LSIL), Candidatus Saccharibacteria (HSIL), and Streptococcus spp./Bacteroides fragilis (CC).

HC vs CC contained the most DABs (35), and LSIL vs HSIL the fewest (13). Co-occurrence network complexity peaked in LSIL/HSIL (41 correlated pairs) and declined in CC (28 pairs). Ninety-two differential KEGG pathways were identified, with 60 enriched in LSIL.

L. iners displayed dual correlations with diverse metabolic pathways, indicating comprehensive remodeling of vaginal microbiota structure, interactions and functions across progressive cervical lesions.</p>Conclusion<p>Vaginal microbiota undergoes progressive dysbiosis during the progression from high-risk HPV infection to CC in postmenopausal women. Distinct microbial alterations are observed at each disease stage, with substantial functional remodeling occurring at the LSIL stage.

These findings provide a reference for early intervention and research on microbial biomarkers.</p>