Why It Increases — and What You Can Do.
When women move through perimenopause and menopause, the focus is often on hot flushes, mood changes, and sleep disruption.
But one of the most significant — and frequently overlooked — shifts happens within the vaginal microbiome.
Changes in this delicate microbial ecosystem can increase susceptibility to bacterial vaginosis (BV), urinary tract infections (UTIs), irritation, and discomfort.
Let’s explore why this happens — and how to support your vaginal health naturally.
Why the Vaginal Microbiome Matters
The vaginal microbiome is a dynamic ecosystem typically dominated by Lactobacillus species. These beneficial bacteria:
- Produce lactic acid to maintain an acidic pH (3.8–4.5)
- Inhibit the overgrowth of harmful bacteria and yeast
- Support immune function and mucosal integrity
When Lactobacilli are thriving, they create a protective barrier against infection and inflammation.
Why The BV Risk Becomes More Common During Menopause
As estrogen declines during perimenopause and post-menopause, several changes occur:
- Vaginal glycogen levels drop
- pH rises (often above 5.0)
- Lactobacillus populations decrease
- Opportunistic bacteria such as Gardnerella vaginalis and Escherichia coli may proliferate
This shift contributes to microbial imbalance and may form part of Genitourinary Syndrome of Menopause (GSM) — affecting up to 50% of postmenopausal women.
What Is BV?
Bacterial vaginosis occurs when protective Lactobacilli are outnumbered by anaerobic bacteria.
Common symptoms include:
- Thin grey or white discharge
- Strong “fishy” odour (often after intercourse)
- Vaginal irritation
- Elevated pH (>4.5)
Up to 50% of women may be asymptomatic.
Untreated BV may increase the risk of:
- Recurrent UTIs
- Pelvic inflammatory disease (PID)
- Post-coital infections
- Ongoing inflammation
BV is often mistaken for thrush — but treatment approaches are completely different
Signs Your Vaginal Microbiome May Be Out of Balance
- Vaginal dryness, burning, or itching
- Persistent odour
- Pain during intercourse
- Recurrent UTIs
- pH consistently above 4.5
If symptoms persist, investigating the microbiome is often more effective than repeatedly using short-term treatments.
Natural Strategies to Support Vaginal Balance in Menopause
As a naturopath, I focus on restoring the terrain — not just suppressing symptoms.
1. Strain-Specific Probiotics
Look for clinically studied strains such as:
- Lactobacillus crispatus
- L. jensenii
- L. gasseri
In some cases, vaginal administration may be more effective than oral supplementation alone.
Always use under practitioner guidance.
2. pH-Balanced Moisturisers & Lubricants
Choose products that:
- Match vaginal pH
- Are free from fragrances and parabens
- Support mucosal barrier integrity
- Brands like VeeForMe Soothe & Plump, Olive & Bee, and YES offer natural, barrier-friendly options
Avoid harsh cleansers and “feminine hygiene” washes.
3. Topical Vaginal Oestrogen (When Appropriate)
Low-dose estriol or estradiol may:
- Improve tissue thickness
- Restore glycogen levels
- Support Lactobacillus regrowth
This should always be discussed with your healthcare practitioner.
4. At-Home pH Testing
Regular pH monitoring can detect an imbalance early.
A reading above 4.5 may signal the need for further investigation.
5. Vaginal Microbiome Testing
For persistent or recurrent symptoms, comprehensive testing can provide clarity.
The at-home vaginal microbiome & dysbiosis test assesses:
- Vaginal pH
- Beneficial bacteria
- Opportunistic bacteria
- Fungal pathogens
- Viruses and parasites
The kit includes:
- Simple self-collection swab
- Easy instructions
- Express postage to the laboratory
Results are reviewed in consultation, allowing for a personalised treatment plan based on your unique microbiome profile.
Learn more here about how you can order yours today.
6. Nutritional Support
Diet plays a role in immune resilience and microbial balance.
Supportive nutrients may include:
- Omega-3 fatty acids for anti-inflammatory action
- Phytoestrogens (soy, flaxseed, red clover) to gently support estrogen receptors
- Zinc and vitamin E for tissue healing
- Sea buckthorn oil for mucosal hydration
Diets high in refined sugars, ultra-processed foods, and trans fats may contribute to inflammatory activation and microbial disruption.
Individual guidance is recommended.
7. Practical Hygiene Guidelines
During active symptoms:
- Avoid douching (as this may introduce new pathogens)
- Avoid scented soaps and feminine hygiene products
- Avoid tampons (until symptom-free for 6 months)
- Avoid using sterilised wipes or steroid creams (unless prescribed)
- Wear breathable cotton underwear
- Change out of wet clothing promptly
- Avoid tight synthetic garments
- Pause sexual activity until symptoms resolve
- Keep the vaginal area as dry as possible during infection
- Avoid excessive exercise, which may lead to excessive sweating/moisture in this area, worsening symptoms
Gentle care and reduced irritation support recovery.
When to Seek Help
Recurrent BV and vaginal symptoms are common — but they are not simply “part of aging.”
If you’re experiencing persistent discomfort, odour, recurrent infections, or unexplained changes, targeted investigation can help restore balance.
Final Thoughts
Menopause brings change — but chronic vaginal discomfort doesn’t have to be part of it.
With the right assessment and support, it’s possible to:
- Restore microbial balance
- Improve comfort and intimacy
- Reduce recurrent infections
- Support long-term urogenital health
Book a naturopath consultation or discovery call today to explore personalised support options for your vaginal microbiome—naturally.
Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare practitioner before changing your health regimen.
References
Bradfield Strydom M. Supporting the vaginal microbiome during menopause. ATMS Journal. 2023
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Kaambo E, Africa C, Chambuso R, Passmore JAS. Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis. Frontiers Public Heal. 2018;6:78. doi:10.3389/fpubh.2018.00078
Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol. 2012;66:371–389.
Mitchell C, Fredricks D, Agnew K, Hitti J. Hydrogen peroxide-producing lactobacilli are associated with lower levels of vaginal IL-1β, independent of bacterial vaginosis. Sex Transm Dis. 2015;42(8):403–407.
Hillier SL, et al. Role of bacterial vaginosis-associated anaerobes in HIV infection and adverse pregnancy outcomes. Clin Infect Dis. 1993;16(Supplement_4):S271–S273.
Wilson JD, Lee RA, Balen AH, Rutherford AJ. Bacterial vaginal flora in relation to changing oestrogen levels. Int J STD AIDS. 2007;18(5):308-311. doi:10.1258/095646207780749583
