IRON DEFICIENCY ANEMIA AND VAGINAL MICROBIOTA ALTERATIONS: INSIGHTS FROM FEMOFLOR PCR RESULTS

nutritional disorders affecting women of reproductive age worldwide. While its hematological effects are well recognized, its impact on the vaginal microbiome remains insufficiently studied. This study aimed to investigate the mechanisms of vaginal microbiota changes in women with IDA using quantitative multiplex real-time PCR (Femoflor-16 assay). A total of 128 non-pregnant women aged 18–45 years were enrolled: 68 with confirmed iron deficiency anemia (hemoglobin <120 g/L, serum ferritin <30 μg/L) and 60 healthy controls with normal iron status. Vaginal microbiota composition was analyzed using the Femoflor-16 test, which quantifies total bacterial mass and key microbial groups. Results showed a dramatic shift in vaginal microbiota among women with IDA. Lactobacillus spp. proportion decreased significantly (31.7 ± 24.3% vs. 72.4 ± 18.6% in controls, p < 0.0001). Absolute normocenosis was observed in only 22.1% of the IDA group compared to 68.3% in controls. Severe anaerobic dysbiosis was detected in 48.5% of anemic women versus 6.7% in healthy controls (p < 0.001). Opportunistic anaerobes such as Gardnerella/Prevotella/Porphyromonas, Atopobium vaginae, Sneathia/Leptotrichia, and Megasphaera groups were markedly increased. Elevated soluble transferrin receptor (sTfR) levels were independently associated with severe dysbiosis. The main mechanisms linking IDA to vaginal dysbiosis include impaired lactoferrin-mediated iron sequestration, weakened mucosal immunity, elevated vaginal pH due to Lactobacillus depletion, and selective advantage of iron-efficient pathogens. These changes create a vicious cycle favoring anaerobic overgrowth and biofilm formation. The study concludes that iron deficiency anemia is strongly associated with vaginal dysbiosis and highlights the clinical importance of routine molecular microbiota screening in anemic women. Integrated management combining iron repletion with microbiota-targeted interventions (probiotics and lactoferrin) may reduce reproductive complications.