Lactobacilli and Why It’s Important for the Vaginal Microbiome — Especially During Menopause

Did you know that your vagina is home to more than 250 species of bacteria?¹ Just like your gut, your vagina has a microbiome, an ecosystem of microorganisms like bacteria, fungi, protozoa, yeasts, and viruses. And just like your gut, your vagina can benefit from probiotics—but not just any probiotics. If you’ve ever experienced uncomfortable symptoms such as itching, odor, and discharge, it can feel like your vagina has a (fickle) mind of its own. But every day, science is making strides in figuring out exactly what keeps the vagina at its healthiest and most balanced. Here’s what we know.

Lactobacillus Bacteria Protect Your Vaginal Health

Unlike the gut microbiome, which thrives on diversity, the vaginal microbiome is actually its healthiest when it’s dominated by lactobacillus bacteria. Lactobacilli have an important job, inhibiting the binding of other bacteria to vaginal cells as well as producing lactic acid and hydrogen peroxide that kills or inhibits the growth of many other harmful bacteria.² When an overgrowth of anaerobic bacteria (doesn’t require oxygen) replaces the lactobacilli and causes an increase in vaginal pH, it can lead to symptoms such as itching, odor, and increased discharge. Bacterial vaginosis, which is one of the more common vaginal infections potentially caused by the disruption of a balanced microbiome,³ is more than just the uncomfortable physical symptoms associated with it—women with bacterial vaginosis can also be at an increased risk for urinary tract infections and, in more severe cases, pelvic inflammatory disease.⁴

The Lactobacillus-Vagina Connection: How Menopause Disrupts Your Microbiome

Your vaginal microbiome and levels of lactobacillus bacteria change throughout your life—and even throughout the month, in response to factors like stress, sexual activity, menstruation, and smoking. But the vaginal microbiome is especially vulnerable during perimenopause, menopause, and postmenopause, and its composition may have a profound effect on vaginal atrophy, vaginal dryness, sexual health and overall quality of life, during this time.⁵

Thanks to a drop in estrogen that can result in decreased lactobacilli, subsequently disrupting the microbiome, postmenopausal women can be more susceptible to vaginal infections.⁶ Lower levels of estrogen can also change the vagina on a cellular level, contributing to menopausal vaginal atrophy—the official term for when vaginal tissue thins and becomes less elastic. Other common vaginal and urinary symptoms experienced during menopause can include dryness, burning, and irritation, pain and lack of lubrication during sex, weaker orgasms, and worsening bladder control, painful urination, and recurring urinary tract infections.⁷

Do Probiotics for Vaginal Health Really Work?

More research is still needed, but the studies that have been done on probiotics for vaginal health so far, are promising. There are over 170 species of lactobacillus bacteria,⁸ with lactobacillus rhamnosus and casei being the most commonly found in the human body in general, and lactobacillus acidophilus making up most of the healthy vaginal lactobacillus flora.⁹ Lactobacillus acidophilus is also the most-researched strain of probiotic when it comes to the vaginal microbiome.

Lactobacillus rhamnosus and lactobacillus reuteri are two other strains that seem promising for promoting and maintaining vaginal health.¹⁰ That said, more research into ​​the inherent differences within and between women in different ethnic groups, when it comes to the kinds of bacteria found in the vaginal microbiome of healthy women, is still needed.

Probiotics for vaginal health seem like they may be especially helpful for women who are plagued with recurrent infections of bacterial vaginosis, yeast infections or vaginal symptoms such as irritation, discharge and odor. One study found that G. vaginalis, a bacterium associated with bacterial vaginosis, was reduced beyond detectable limits for 21 days after just a single use of a lactobacilli probiotic vaginal insert. Another study found that using a probiotic vaginal insert with lactobacillus rhamnosus, was linked to increased levels of some vaginal antimicrobial defenses.¹¹

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Studies of probiotics taken orally for vaginal health are also promising and have demonstrated that women taking a probiotic containing specific strains of lactobacillus rhamnosus and lactobacillus reuteri were more likely to have a lactobacilli-dominated, normal vaginal microbiome. In these studies, even 28 days and 60 days after taking the probiotic, study participants still had a greater number of vaginal lactobacilli than women who didn’t take a probiotic.¹²

According to researchers, the ability of oral probiotics to convert some women from an unbalanced vaginal microbiome to normal “goes beyond the proof-of-concept stage and provides a method for women to help maintain vaginal health.”¹³

It’s important to remember that the benefits of probiotics for vaginal health are strain-specific and that results with one doesn’t necessarily guarantee positive results with a similar strain—so be sure to check the label. Probiotics geared towards vaginal health have been shown to offer significant health benefits when used to support the balance of the vaginal microbiome, especially during perimenopause, menopause, and beyond. And since they’ve been found safe to use, it’s often worth a try for women dealing with symptoms.

Resources

1. https://linkinghub.elsevier.com/retrieve/pii/S0002962915310636
2. https://pubmed.ncbi.nlm.nih.gov/28224747/
3. https://pubmed.ncbi.nlm.nih.gov/22746335/  
4. https://www.sciencedirect.com/topics/immunology-and-microbiology/vagina-ph
5. https://pubmed.ncbi.nlm.nih.gov/27451320/ 
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662373/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561742/  
8. https://academic.oup.com/cid/article/60/suppl_2/S98/379146
9. ​​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC120688/
10. https://www.healthline.com/health/vaginal-health/probiotic-vaginal-health#good-probiotic-strains
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662373/
12. ​​https://pubmed.ncbi.nlm.nih.gov/12628548/
13. ​​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662373/