FIG 4.

Vaginal microbial diversity, stability, and Lactobacillus correlate with previously established estradiol levels (52) across the menstrual cycle. The Shannon index (a, d, and g) and log Jensen-Shannon rate of change (b, e, and h) increase during menses, with a concurrent decrease in Lactobacillus relative abundance (c, f, and i). Participants not using hormonal contraceptives (a to c, n = 4), using estrogen and progestin combined, systemically released contraceptives (d to f, n = 2), or using progestin-only, locally released contraceptives (g to i, n = 2) are shown. The local regression (loess) estimates of diversity, stability, and Lactobacillus correlate (Spearman correlation) with estradiol values transformed from Minassian and Wu (52) (m) for participants not using hormonal contraceptives (j to l). Spearman correlations (ρ) and P values are displayed in panels j to l. The shaded regions in panels a to i and panel m are 95% confidence bands of the local regression fit. Red lines indicate the first 5 days when menses typically occurs.