Written by Lucy Sanderson, Human Nutrition Graduate, edited by Laura Clark
Your vaginal microbiome is a dynamic and ever-changing ecosystem filled with bacteria, fungi, and other microorganisms that work together to maintain vaginal health. However, during menopause, hormonal shifts, especially the decline in oestrogen can significantly alter this delicate balance. Understanding these changes is key to managing symptoms and maintaining vaginal well-being during this life stage.
The Role of Oestrogen in Vaginal Health
Oestrogen does more than regulate your menstrual cycle, it also plays a crucial role in maintaining the structure and function of the vaginal environment. One of its primary functions is supporting the growth of Lactobacillus bacteria, which help keep the vaginal pH low (around 3.5 to 4.5) by producing lactic acid. This acidic environment is essential for preventing infections by inhibiting the growth of harmful bacteria and pathogens.
How Menopause Changes the Vaginal Microbiome
1. Decline in Lactobacilli
The two most important species of Lactobacillus; Lactobacillus crispatus and Lactobacillus iners, play a protective role in vaginal health. But as oestrogen levels drop during menopause, these beneficial bacteria can decrease as well. This leads to a higher vaginal pH (above 4.5), making the environment more susceptible to infections.
2. Increase in Harmful Bacteria
With fewer Lactobacillus species to maintain balance, opportunistic and potentially harmful bacteria, such as Gardnerella vaginalis, Prevotella, and Atopobium, can take over. This imbalance often results in bacterial vaginosis, which can cause unpleasant symptoms like odour, discharge and irritation.
3. Higher Risk of Infections
A disrupted vaginal microbiome doesn’t just lead to bacterial vaginosis, it can also make postmenopausal women more prone to yeast infections and urinary tract infections (UTIs). Without enough Lactobacillus to keep harmful microbes in check, the vaginal ecosystem becomes more vulnerable to these common infections.
Taking Control of Your Vaginal Health
While these changes can be frustrating, there are ways to support your vaginal microbiome during menopause. Probiotics, vaginal moisturizers, and hormone replacement therapy (HRT) may help restore balance and reduce the risk of infections. Always consult with your menopause specialist to find the best approach for your individual needs.
The Role of Probiotics
Probiotics are live bacteria that can help restore balance in the body’s microbial ecosystems. When it comes to vaginal health, the strains that matter most are those naturally found in the vagina, particularly Lactobacillus species such as Lactobacillus crispatus, Lactobacillus rhamnosus, and Lactobacillus reuteri. These bacteria help keep vaginal pH low and prevent harmful microbes from taking hold.
Research into probiotics for vaginal health is growing. Some studies suggest that supplements containing specific Lactobacillus strains may reduce the risk of bacterial vaginosis and urinary tract infections, especially in postmenopausal women. Products designed for women’s health often contain L. rhamnosus GR-1 and L. reuteri RC-14, which are among the most studied for supporting urogenital health.
It is worth noting that not all probiotics are the same, and the benefits depend on the exact strain and how it is taken. Oral probiotics may offer indirect support through the gut–vaginal connection, while vaginal probiotic pessaries or capsules are being studied for more direct benefits. If you are considering probiotics, look for products formulated specifically for women’s health, and always check with your menopause specialist to make sure they are right for you.
Menopause is a natural transition, but it doesn’t have to mean discomfort. By understanding how your vaginal microbiome changes and taking steps to support it, you can maintain better vaginal health and overall well-being.
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