Microbiome-Based Therapeutic Innovations for Improving Gynecological and Obstetric Health

The vaginal microbiome has emerged as a fundamental determinant of female reproductive health and a promising therapeutic target for the prevention and management of gynecological and obstetric complications. This review aimed to critically analyze the current scientific evidence regarding emerging microbiome-targeted therapeutic approaches, emphasizing their biological mechanisms, clinical effectiveness, therapeutic potential, and future applications in personalized reproductive medicine. A structured narrative review based on the Scientific Method was conducted using publications retrieved from internationally recognized databases, including PubMed, Scopus, Web of Science, ScienceDirect, SpringerLink, Nature Portfolio, and Google Scholar. Recent evidence demonstrates that vaginal dysbiosis is strongly associated with bacterial vaginosis, recurrent vulvovaginal candidiasis, infertility, recurrent urinary tract infections, preterm birth, and other adverse pregnancy outcomes. The analyzed literature indicates that probiotics currently possess the strongest clinical evidence, while live biotherapeutic products, vaginal microbiota transplantation, postbiotics, prebiotics, and advanced vaginal drug delivery systems represent rapidly evolving therapeutic alternatives with considerable potential for restoring microbial homeostasis. These interventions extend beyond pathogen elimination by promoting immune regulation, epithelial barrier integrity, long-term microbial stability, and personalized therapeutic strategies. Although important methodological limitations remain, including heterogeneity among studies and limited long-term clinical data, microbiome-directed therapies are expected to play an increasingly significant role in precision reproductive medicine. Continued multidisciplinary research and high-quality clinical trials will be essential to facilitate their safe and effective integration into routine gynecological and obstetric practice.