Never heard of the vaginal biome? No, nor had I until recently.
After years of yoghurt adverts reminding you to ‘look after the good bacteria in your gut’, it’s a travesty that the same advice hasn’t been provided about the friendly bacteria found in your vagina. But looking after this clever ecosystem is just as important.
The vaginal biome of healthy bacteria (and friends) plays a crucial role in the composition, function and health of the vagina. Its significance becomes even more pronounced during transitional phases like perimenopause and menopause.
So, what is the vaginal biome, what happens when the ecosystem balance is upset, and what can we do to take care of it?
The Truth About Your Vaginal VIPs
A biome is a naturally occurring community of organisms within its own ecosystem. In this case, the vaginal ecosystem predominantly comprises bacteria, fungi and viruses. These welcome residents each serve a healthy purpose by preventing the growth of harmful or pathogenic organisms, which could cause infections.
A healthy vaginal biome provides the following functions.
1. Regulation of pH Balance
Many of the bacteria in the vagina are from the Lactobacillus family. These primary residents contribute to the maintenance of an acidic environment.
Acidity is vital for creating a hostile environment, inhibiting the growth of harmful bacteria and yeast and safeguarding against infections such as bacterial vaginosis and candidiasis (thrush).
2. Immune Support
The vaginal biome communicates with the immune system, increasing defences against pathogens. This symbiotic relationship enhances immune surveillance and response, which is crucial for preventing infections and maintaining vaginal health.
3. Protection Against Pathogens
Lactobacilli produce antimicrobial substances such as hydrogen peroxide and bacteriocins to fortify the vaginal environment with a protective barrier. This prevents colonisation by pathogenic bacteria or viruses.
The Lowdown on Perimenopause, Menopause and the Biome
Perimenopause and menopause are marked by hormonal fluctuations. Declining oestrogen levels significantly influence the vaginal environment, leading to the following changes in the vaginal microbiome.
1. Loss of Lactobacilli Dominance
The fall in oestrogen compromises the vaginal epithelium (lining) and reduces the amount of glycogen available. Glycogen is a type of sugar that acts as a food source for the healthy bacteria.
Consequently, there’s a decline in Lactobacilli, upsetting the balance of the biome. This leads to a more diverse and potentially pathogenic (harmful) community of organisms. If bad bacteria start to grow, you may develop an infection.
2. Greater Infection Risk
Changes in the biome render women more susceptible to vaginal infections. This includes bacterial vaginosis and vulvovaginal candidiasis (thrush). Symptoms such as discharge, itching and discomfort can occur, significantly impacting quality of life.
The fall in oestrogen associated with menopause also causes muscle weakening in the urethra. The combination of weaker muscles and a higher concentration of bad bacteria increases the risk that bacteria will enter your urethra and bladder, causing a urinary tract infection (UTI or water infection).
UTIs can cause significant misery, with sudden urgency, pain, a burning sensation, fever, and, in some cases, incontinence.
3. Risk of Vaginal Atrophy
Loss of oestrogen contributes to thinning of the lining of the vagina, dryness or reduced lubrication, and inflammation. These changes not only predispose women to infections, but can also increase the risk of sexual problems and urinary symptoms.
How to Nurture a Healthy Biome in Perimenopause and Beyond
The vaginal biome plays a pivotal role in a woman’s health. While proactive measures to preserve its integrity are helpful at all ages, they become vital from perimenopause onwards.
1. Probiotics and Prebiotics
Remember those yoghurts we talked about? It turns out they’re not only good for your gut health. Introducing probiotics that contain Lactobacillus strains, or prebiotics that promote Lactobacillus growth, can help to restore and maintain a healthy vaginal biome.
Making yoghurts or supplements containing Lactobacillus part of your usual diet will start replenishing the natural bacterial populations. This will help to keep harmful bacterial growth under control.
2. Hygiene Practices
Swap to gentle hygiene practices, such as using mild, pH balanced cleansers, and avoiding harsh soaps or douches. This is crucial for preserving the natural acidity of the vagina.
Antibiotics can disrupt the vaginal (and gut) microbiome, so avoid taking them unless medically necessary. If you do need to take antibiotics, try to be vigilant about also taking pre- and pro- biotics.
3. Regular Monitoring
If you experience vaginal discomfort or recurrent infections, seek medical advice promptly. Earlier detection and management of vaginal health issues can help to prevent recurrent infections, improving your quality of life.
4. Hormone Replacement Therapy
Women with recurrent infections, or other symptoms relating to low oestrogen, may benefit from hormone replacement therapy (HRT) such as oestrogen replacement or a combined oestrogen and progesterone therapy. HRT can alleviate symptoms of vaginal atrophy and help to restore the vaginal microbiome balance.
For those who do not need HRT for other menopause symptoms, or who prefer not to take a systemic hormone treatment, vaginal oestrogen only preparations are available on prescription. Little of the hormone gets into the rest of your body, making it a preferable option for some. Topical oestrogen is available in the form of a vaginal pessary, cream, gel or ring.
Individual assessment and consideration of the risks and benefits must be carried out by a doctor prior to initiating HRT.
Final Thoughts
The vaginal biome plays a pivotal role in preventing infections and maintaining good overall health. This is particularly important during transitional phases such as perimenopause and menopause. Understanding the connections between hormonal fluctuations and the vaginal ecosystem is essential for preserving vaginal health and preventing discomfort and infections.
Conservative measures such as gentle hygiene practices and the use of probiotics can help keep the biome healthy. However, in some cases HRT may be suggested to maintain optimal vaginal health and overall wellbeing.
About Hannah Rose
Hannah Rose worked as a doctor before becoming a freelance medical copywriter. She is passionate about writing the latest in health to empower individuals to understand and take control of their wellbeing. Contact Hannah here.
