Biotics in Menopausal Health: A Two-Decade Bibliometric Analysis and Narrative Review.

PURPOSE OF REVIEW: Menopause, defined as amenorrhea due to loss of ovarian function, is associated with osteoporosis, metabolic syndrome, vasomotor disturbances, and cardiovascular disease. While menopause hormone therapy (MHT) remains the gold standard for high-potency symptom management, biotic interventions offer a safe, alternative approach for those who cannot or choose not to use MHT. This review examines biotic interventions (probiotics, prebiotics, synbiotics, postbiotics) and their influence on the gut-menopause axis. RECENT FINDINGS: Declining estrogen during menopause alters gastrointestinal physiology, including shifts in gut microbiota composition and impaired gut barrier function. Bibliometric analysis of the past two decades shows a sharp rise in publications after 2017, peaking in 2024. The intellectual landscape centers on "probiotics," "menopause," and "osteoporosis," highlighting bone health as a key focus. Evidence indicates that biotic interventions, particularly Lactobacillus and Bifidobacterium species and selected fibers, can restore microbial balance, enhance short-chain fatty acid production, improve gut barrier integrity, modulate the estrobolome, reduce systemic inflammation, and support bone, metabolic, cardiovascular, and vasomotor health. Biotic strategies represent a multi-targeted, non-hormonal approach to managing menopausal health, addressing underlying physiological changes. These findings highlight emerging research trends while underscoring the need for long-term clinical trials, and support further exploration of personalized, microbiome-targeted interventions in menopause.