The Vaginal Microbiome and Menopause

When you hear the word “microbiome,” you might first think of the gut. The bacterial makeup of your digestive system certainly affects your overall health.

But have you ever considered the microbiome of the vagina? This, too, has a distinct bacterial composition that can tell us why and how we may be more prone or resistant to certain diseases.

Understanding the Vaginal Microbiome

Vaginal bacteria dynamics change throughout the menstrual cycle as a result of hormonal cycles. That means the hormonal changes of menopause also affect the balance of the microbiome. Believe it or not, the vaginal microbiome has been explored for over 150 years. Even so, science is still trying to understand this particular ecosystem.

One thing we do know is that a balanced vaginal microbiome supports reproductive well-being. Imbalances in vaginal bacteria can increase the risk for infertility, spontaneous abortion, and preterm birth, meaning this likely plays a role in menopause, too.

How the Vaginal Microbiome Impacts Menopause

A healthy vagina has a strong population of Lactobacillus bacteria (which creates lactic acid). It is just slightly acidic, with a pH around 5 which helps keep infections at bay. The pH scale goes from 0 to 14, with the strongest acids measuring 0 and the strongest bases measuring 14.

Several things can throw the vaginal pH out of balance:

• Soaps, scented products and douching
• A diet high in refined sugar
• Vaginal intercourse
• Antibiotics
• Poor ventilation from wearing tight, wet undergarments

Dr. Willa Huston, from the University of Technology Sydney, says that “the best thing you can do for your vaginal microbiome is to do nothing at all.”

Why a Healthy Vagina Matters

Research shows that the balance of vaginal bacteria populations, especially Lactobacilli, is strongly impacted by menopause. Some of the vaginal symptoms common to midlife may be related to these microbiome changes.

Menopause and lower estrogen levels cause Lactobacillus levels in the vagina to decrease, which in turn shifts the vaginal pH. Conversely, menopausal hormone therapy that provides estrogen to the body may restore bacterial levels and a pH closer to that of a premenopausal vagina.

One study found that postmenopausal women were more likely to have lower levels of Lactobacillus in their microbiome. Furthermore, those people with lower Lactobacillus levels were more likely to experience the significant vaginal dryness and discomfort called Genitourinary Syndrome of Menopause (GSM).

Healthcare professionals recommend using lubricants and moisturizers designed for the vagina that are closest to the vaginal mucosa as possible, which support a healthy pH balance, have low osmolality, and contain the least amount of additives (and are free of things like parabens, glycols, and preservatives). For most women, this is a midlife routine worth starting now, whether in perimenopause or postmenopause.

How Do I Know If Something Is Off?

One sign of bacterial imbalance is irregular vaginal discharge and discomfort, which can indicate bacterial vaginosis (BV). At any given time, an estimated one-third of women of reproductive age have BV. The inflammation associated with BV can increase one’s risk of contracting sexually transmitted infections. You can read more about BV in the article linked below.

Because the vagina doesn’t talk to us until something is really out of whack, researchers are trying to develop tests for HPV strains, sexually transmitted infections, and the associations between your unique microbiome and conditions like bacterial vaginosis, infertility, and pelvic inflammatory disease. This could be a groundbreaking step toward better insight into what your physiology is trying to tell you.

Tips on Keeping Your Microbiome Healthy

The habits that impact your overall health also play a key role in maintaining the health of your vagina. A diet rich in nutritious whole foods, regular physical activity, and making healthy changes like not smoking are all important in supporting the grand design of the human body.

Research has shown that more frequent exercise can aid in sexual function in postmenopausal women. A 2017 study found that women who were more physically active had higher sexual function scores and lower rates of vaginal dryness a year after menopause.

Probiotics may also play a helpful role in maintaining vaginal bacterial balance in middle age. A 2017 review found that vaginal probiotics alone or in combination with antimicrobial treatments prevented the recurrence of vaginal infection in women with low estrogen levels.

This is important because antibiotics are often prescribed for the treatment of BV and yeast infections (vulvovaginal candidiasis). Because antibiotics are not generally the most effective choice for long-term treatment or prevention, it’s important to be able to leverage the power of probiotics for keeping the vaginal microbiome healthy.

It goes without saying that the vaginal microbiome is one complicated piece in the puzzle of women’s health, and there is a lot more research needed to fully understand the implications of imbalance, especially throughout midlife changes.

Taking more intentional care of your nether regions may have a bigger impact on your menopausal journey than you think. Make sure you get an annual well-woman visit with a healthcare clinician and discuss any concerns you have about your vaginal health.