Vaginal microbiota plays a crucial role in women's reproductive health, and its composition varies throughout different stages of life. In particular, pregnancy alters the vaginal microbiota, with Lactobacillus spp. being predominant in healthy pregnant women. Dysbiosis during pregnancy is linked to adverse outcomes, such as preterm birth. Menopause leads to changes in the vaginal microbiota due to declining estrogen levels, characterized by reduced Lactobacillus sp. and increased diversity of other bacteria, potentially contributing to health issues, such as vaginal dryness and increased susceptibility to infections, such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and preterm birth. This in turn also leads to the risk of being more susceptible to cancer, such as cervical cancer caused by human papillomavirus (HPV), breast cancer, and ovarian cancer. Non-communicable disorders, such as obesity and diabetes mellitus, also influence the vaginal microbiota and affect reproductive health outcomes. Interactions between vaginal microbiota and sexually transmitted infections (STIs) further influence disease susceptibility and progression. Understanding these dynamics is crucial for developing interventions to promote healthy vaginal microbiota and improve reproductive health in women. This comprehensive review examines the evolution of vaginal microbiota from birth through menopause and its implications for various health conditions and reproductive outcomes and to manage potential imbalances in this ecosystem. © 2025 Elsevier B.V., All rights reserved.