How Menopause can change your Vaginal Microbiome

Your vaginal microbiome is strongly influenced by your ethnicity and is mostly comprised of the bacteria genus, Lactobacillus. Research demonstrates that if you are an African-American or Hispanic decent, that you might have other species that are dominate other than Lactobacillus (Ravel et. al. 2011).

Lactobacillus produce an acidic environment in your vagina. Most pathogens won’t exist in an acid environment and therefore, it is very beneficial to have a dominance of Lactobacillus species. Lactobacillus species feed off a carbohydrate called glycogen. Where does glycogen come from? Glycogen is expressed from oestrogen!

During menopause your oestrogen and progesterone levels naturally decline. This means LESS fuel to FEED the Lactobacillus species. Lactobacillus numbers decline and vaginal dysbiosis can occur. This where there is an imbalance in the vaginal microbiome and pathogens can have a party!

What type of pathogens?

Vaginal dysbiosis can create an environment for Bacterial Vaginosis (BV), Vulvovaginal candidiasis (also known as thrush. Thrush is not common during menopause- one good thing!), there is also more of a risk in developing an STI (sexually transmitted infection). This can also be because your pH balance may shift to a more alkaline balance. Healthy vaginal pH levels are between 3.6-4.5.

With the decrease in oestrogen levels and a risk in having lower Lactobacillus species in your vaginal cavity, this also makes the lining of your vagina thin (causing vaginal atrophy) and can lead to irritation, painful intercourse, and tearing. These symptoms are also associated with Genito-urinary Syndrome of Menopause (more on that in another post!)

Other factors to consider..

Menopause comes with a lot of changes; mentally, stress levels are generally high, physically, metabolically, and neurologically (plus if you have any other comorbid conditions to add into the mix).

Natural ways to feed your Lactobacillus species

Fortunately, there are natural ways that you can increase your Lactobacillus species and support irritation (yay!):

Diet: Eat foods that are high in polyphenols or contain phyto-estrogens (as long as there in no history of oestrogen dominant cancers).

Create an acidic environment: There are pessaries that are high in lactic acid and can be inserted into your vagina to increase acid levels. Probiotics can either be taken orally or vaginally to increase Lactobaciluus species (probiotic needs to be strain specific for your vaginal microbiome) and with the rise in Lactobacillus species, this will create a more acidic pH.

Green tea taken in a capsule (or in a herbal tincture) orally and vaginally to recolonise Lactobacillus species (Tuzil. J., 2020) and has anti-microbial properties (Kim, YW., 2013) for treating vaginal dysbiosis. Also drinking green tea will help too. Green tea is also a polyphenol, which is also another reason why it is beneficial.

Lactulose is a carbohydrate that can be used as a fuel for your healthy vaginal microbes and increase your Lactobacillus species due to its prebiotic activities (Collins et. al. 2018) . This can be taken as a pessary and inserted into your vagina or used as an irrigation. There is a green tea and lactulose capsule that is also available that can be taken orally or vaginally, or you can take it as a liquid. For some people, lactulose can cause unwanted tummy symptoms such as bloating, abdominal pain or loose stools. Another option is to dip a tampon in 6ml of liquid lactulose and insert into your vaginal canal (the tampon needs to have absorbed the liquid, but not too much where you can’t insert).

Alternative options for other symptoms:

• Vaginal atrophy can be soothed with oil based lubricants such as sea buckthorn (Larmo, P.S., 2014) and Vitamin D (Riazi, H. 2019) used topically and taken orally. Other oil based lubricants that can be purchased online are: Olive and Bee Intimate Cream (used to soothe vulva and vaginal tissue) or can be used as a personal lubricant during intercourse, Sea Buckthorn oil by Byron Bay Love Oils soothes and regenerates vaginal tissue integrity, YES OB lubricant is an oil based lubricant used as a massage oil or a personal lubricant during intercourse or try Vitamin E capsules (Porterfield, L. et. al. 2022) that can either be inserted internally into the vagina or a capsule can be broken and used to heal and soothe your vulva and labia majora.

• Fennel oil can be used to reduce inflammation and support vaginal atrophy. Fennel oil can used as a personal lubricant, topically with olive oil, as a moisturiser, or in a pessary (Yaralizadeh, M. et. al. 2016)

• Vitamin D is a promotor of the proliferation of the vaginal epithelium (Gilbert, 2023) and can be used as a capsule inserted into the vagina.

What next?

Perhaps you are able to self administer some of your symptoms or you can go one step further and complete of Vaginal Microbiome test and discover what microbes are living in your vagina! Everyone is individual and there are many external (and internal) factors that can influence the health of your vagina. The benefits of visiting a naturopath is that they can also include other aspects that might be influencing your vaginal microbiome.

As I mentioned above, these symptoms are part of Genito-Urinary Syndrome of Menopause. You can read more on this here.

References:

Collins, S. L., McMillan, A., Seney, S., van der Veer, C., Kort, R., Sumarah, M. W., & Reid, G. (2018). Promising Prebiotic Candidate Established by Evaluation of Lactitol, Lactulose, Raffinose, and Oligofructose for Maintenance of a Lactobacillus-Dominated Vaginal Microbiota. Applied and environmental microbiology, 84(5), e02200-17. https://doi.org/10.1128/AEM.02200-17

Gilbert G.G. Donders & Francesca H.W.V. Donders (2023) New developments in the management of vulvovaginal atrophy: a comprehensive overview, Expert Opinion on Pharmacotherapy, 24:5, 599-616, DOI: 10.1080/14656566.2023.2194017

Kim, YW., Chun, H.J., Kim, IW. et al. RETRACTED ARTICLE: Antimicrobial and antifungal effects of green tea extracts against microorganisms causing vaginitis. Food Sci Biotechnol 22, 713–719 (2013). https://doi.org/10.1007/s10068-013-0136-3

Larmo, P. S., Yang, B., Hyssälä, J., Kallio, H. P., & Erkkola, R. (2014). Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: A randomized, double-blind, placebo-controlled study. Maturitas, 79(3), 316–321. https://doi.org/10.1016/j.maturitas.2014.07.010

Porterfield L, Wur N, Delgado ZS, Syed F, Song A, Weller SC. Vaginal Vitamin E for Treatment of Genitourinary Syndrome of Menopause: A Systematic Review of Randomized Controlled Trials. J Menopausal Med. 2022 Apr;28(1):9-16. https://doi.org/10.6118/jmm.21028

Ravel, J., Gajer, P., Abdo, Z., Schneider, G. M., Koenig, S. S. K., McCulle, S. L., Karlebach, S., Gorle, R., Russell, J., Tacket, C. O., Brotman, R. M., Davis, C. C., Ault, K., Peralta, L., & Forney, L. J. (2011). Vaginal microbiome of reproductive-age women. Proceedings of the National Academy of Sciences - PNAS, 108(Supplement 1), 4680–4687. https://doi.org/10.1073/pnas.1002611107

Riazi H, Ghazanfarpour M, Taebi M, Abdolahian S. Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review. J Menopausal Med. 2019 Dec;25(3):109-116. https://doi.org/10.6118/jmm.19194

Tuzil J, Filkova B, Jircikova J, et al. Tea Extract Vaginal Ovule for Intermediate Flora: Randomized Blinded Vehicle-Controlled Multicenter Pilot Clinical Trial with Microbiome Analysis. Journal of Biologically Active Products from Nature. 2020;10:357-372.

Yaralizadeh, M., Abedi, P., Najar, S., Namjoyan, F., & Saki, A. (2016). Effect of Foeniculum vulgare (fennel) vaginal cream on vaginal atrophy in postmenopausal women: A double-blind randomized placebo-controlled trial. Maturitas, 84, 75–80. https://doi.org/10.1016/j.maturitas.2015.11.005