Bacterial Vaginosis and Menopause: More Common Than You Think

Unfortunately, one of the effects of changing hormones around menopause is a disruption of the natural balance of yeast and bacteria in the vagina. Bacterial vaginosis (BV) is one of the unpleasant potential outcomes of this shift.

The vagina has its own microbiome, an environment of normal and healthy bacteria and yeast. When something disrupts this environment, the balance of these microbes changes. Vaginitis refers to microbiome disruption that causes inflammation, pain, irritation, redness and abnormal discharge.

Yeast infections (candidiasis) are a type of vaginitis that result from an overgrowth of candida yeast.

BV is vaginitis that occurs when healthy lactobacilli bacteria are overwhelmed by other types of bacteria.

Who Is Affected by BV?

It’s often thought that BV primarily affects younger women. However, BV affects women of any age and becomes more common with age.

Depending on the study, researchers estimate that 8-75% of women have BV at any given time. The majority, however, do not have symptoms. The prevalence of BV increases after menopause, and continues to increase with age.

The prevalence of BV increases with age, estimated 29% of women from age 14-49 have BV at any given time, but 84% do not have symptoms.

What Causes BV?

Someone develops BV when the chemical environment of the vagina changes and the predominant species of bacteria shifts away from Lactobacillus. The newly dominant species of bacteria are responsible for the changes in odor and consistency of vaginal discharge that can inflame vaginal tissue.

Ultimately, decreased estrogen levels are an important risk factor for BV. Because estrogen directly influences the levels of Lactobacillus species in the vaginal microbiome, the decline of estrogen around menopause directly affects this healthy bacteria and opens the door for vaginitis.

Soaps, douches, scented sprays, powders and wipes are major risk factors for BV because they change the chemical environment and disrupt the normal vaginal microbiome. There is almost never a reason to use any of these products or wash your vagina directly with soap. Steer clear for your health!

Symptoms of BV and Diagnosis

Approximately half of women with BV do not have symptoms. Those who do have symptoms report a “fishy” smell, itching, and increased vaginal discharge.

Your healthcare provider will ask about color, consistency, volume, and odor of vaginal discharge and may also collect a sample for further analysis. Laboratory analysis will differentiate between BV and other causes of vaginitis, such as yeast infection.

In addition to thicker and larger volumes of discharge, people with BV typically experience vaginal pain, swelling, and irritation.

Untreated BV can lead to long-term complications such as pelvic inflammatory disease and intrauterine infections. So, it’s important to get treatment if you develop symptoms. If you’re sexually active, it’s another reason to practice safer sex with barrier methods like condoms.

Treating BV

BV is treated primarily with oral or vaginal antibiotics like metronidazole and clindamycin. The CDC recommends testing for BV before treatment to minimize the use of antibiotics.

Patients that are positive for BV but do not have symptoms are often not given antibiotics. BV can self-resolve, and using antibiotics creates its own risk of yeast infection due to further alteration of the vaginal microbiome.

If your sexual partner also has a vagina, they should also be tested and treated. BV is not transmitted to partners with a penis, but a recurrence of BV is more likely if your partner has a vagina.

BV is not considered a sexually transmitted infection (STI), but penis-in-vagina intercourse can increase your risk for it. BV also increases the risk of co-infection with a STI, so your provider may recommend screening for STIs at the same time.

Emerging Trends In Preventing BV

Given the increased incidence of BV after menopause, recent studies have focused on the prevention of BV in postmenopausal women with estrogen therapy and probiotics.

Menopausal hormone therapy (MHT) was found to increase the levels of Lactobacillus in post-menopausal women, decreasing the incidence of BV.

Oral probiotics have also shown some promising results. As medical research learns more about the negative effects of over-prescribing antibiotics, including antibiotic resistance, finding alternative strategies is becoming more important.

Patients treated for BV with both probiotics and antibiotics had more effective treatment and less recurrence than those treated with antibiotics alone.

Before starting any medications or supplements, speak with your healthcare provider regarding the risks and benefits of each in relation to your unique medical history.

Meanwhile, treat your vaginal microbiome with care. Let your vagina clean itself and avoid any products with soaps or scents in the vulva and vagina. Practice safer sex with barrier methods if you have new or multiple sexual partners.

If you suspect you have BV, schedule an appointment with your healthcare provider. Your vaginal microbiome will be happy you asked!