The Vaginal Microbiome and Menopause

The Vaginal Microbiome and Menopause

When you hear the word “microbiome,” you might first think of the gut, and how the bacterial makeup of our digestive system affects our 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 well as during the phases of menopause and are representative of the relationship between our microbiome and its host: us. Believe it or not, the vaginal microbiota has been explored for over 150 years. Even so, not much is yet understood regarding this particular ecosystem.

How the vaginal microbiome impacts menopause

It is so complex that a lot more research needs to be done before we clearly know how vaginal bacteria impacts specific conditions and phases of life, like menopause, and ultimately how to use this information to improve upon women’s health. 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.

The importance of your vaginal pH balance

A healthy vagina has a nice balance of Lactobacillus (which creates lactic acid) and is just slightly acidic, with a pH around 5 (as a reminder from 9th-grade science, the pH scale goes from a very acidic 0 to a very basic 14), which helps keep infections at bay.

Several things can throw our pH out of its delicate balance, like the use of certain soaps or scented products, a diet high in refined sugar, intercourse, use of antibiotics, douching, and poor ventilation from wearing improperly fitted, wet, or non-cotton panties. Also, your mom knew what she was talking about when she taught you to wipe from front to back only. 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 is crucial during menopause

Research shows that the balance of vaginal bacteria, especially that of Lactobacilli, is strongly impacted by menopause and that imbalances in the microbiome are related to vaginal symptoms some women experience during this midlife change. Lactobacilli appear to decrease with menopausal changes but can be restored with hormone replacement therapy in postmenopausal women. In fact, a 2018 study indicated that women who had a Lactobacillus dominant microbiota experienced the largest improvement in “most bothersome symptoms” of menopause during a hot flash treatment trial.

The vagina so rarely gives us reason to be concerned about our health “down there” that we may not think much about it. However, like everything else in our body, the vagina undergoes some changes as we get older that may eventually become more noticeable. It loses its elasticity, becomes thinner, and can become drier. Vulvovaginal atrophy has been linked to a vaginal microbiome that has a low presence of Lactobacillus, a correlation worth further studying to create better methods of preventing atrophy in menopausal women. It’s important to start paying attention to moisture and pH balance to maintain good vaginal health through these natural changes.

Vaginal dryness is common during menopause

The most common problem reported during menopause is vaginal dryness, which can cause painful intercourse. This dryness is due to the loss of estrogen that occurs naturally as we age. Using vaginal moisturizers, or investing in a vibrator to keep muscles active, can help prevent excessive dryness that can create bacterial imbalances as we get older.

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.

What you need to know about vaginal bacteria

One sign of bacterial imbalance is irregular vaginal discharge or, which can indicate bacterial vaginosis (BV), a condition experienced at any given time by nearly one-third of women of reproductive age. The inflammation associated with BV can increase one’s risk for contracting sexually transmitted infections.

Probiotics may also play a helpful role in maintaining vaginal bacterial balance in middle age. A 2017 review of probiotics in the prevention and treatment of postmenopausal vaginal infections found that vaginal probiotics by themselves, or when combined with antimicrobials, had a positive impact on the microflora, preventing recurrence of these infections in women with low estrogen levels. This is important because antibiotics are often prescribed for the treatment of BV and vulvovaginal candidiasis (the two most common postmenopausal vaginal infections), but antibiotics are not generally the most effective choice for long-term treatment or prevention. Probiotics appear to be promising in the rebalance of the vaginal microbiota during the phases of menopause.

Tips on keeping your vagina healthy

The habits that impact our overall health play a key role in maintaining the health of our organs, too, including the vagina. Choosing a diet rich in nutritious, whole foods, engaging in regular physical activity, and practicing recommended lifestyle behaviors 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 that included 1927 women-years showed that women who were more physically active had higher sexual function scores and that a year after menopause, the prevalence of vaginal dryness was 62% to 67%.

Because the vagina doesn’t usually yell when something is out of whack, there is now a better way to assess how things are going downstairs. SmartJane™ by uBiome is the first test designed to tell us what exactly is going on in our vaginal microbiome, providing information around what types of HPV or sexually transmitted infections may be present, 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 our physiology is trying to tell us.

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 middle age changes. Until we know more, the time to start taking more intentional care of our nether regions is right now – it may have a bigger impact on our menopausal journey than we know.

Whether you’re just starting to dip your toes into perimenopause, continuing to experience symptoms into postmenopause, or simply looking for some guidance on what to expect in the coming years of life, we’re here for you! For more information and support around your menopause journey, as well as ideas for symptom relief, join us over at Lisa Health.


Dr. DePree is the Director of Women’s Midlife Services at Holland Hospital in Holland, Michigan, and has practiced as a board-certified gynecologist and women’s health provider for 30 years. She is a certified menopause specialist and in 2013 was named Certified Menopause Practitioner of the Year by the North American Menopause Society for “exceptional contributions” to menopause care. Dr. DePree also founded the groundbreaking website, a site focused on educating women about sexual well-being, particularly during the menopause transition, and offering curated products that support vaginal health and sexual wellness.