Yeast Infections vs. Bacterial Vaginosis During Menopause

Your vaginal discharge is off, you’re itchy, and even your scent seems different...and not in a good way. You’re sure you have a yeast infection—or is it bacterial vaginosis? Before you self-diagnose, read on. 

The Vaginal Microbiome 

The vaginal microbiome is the ecosystem of microorganisms, mostly bacteria, that are normally present in the vagina. A healthy vaginal microbiome is thought to be largely composed of lactobacillus bacteria. When it’s not—and when an imbalance of these microorganisms exists in the vaginal microbiome instead—you can be more susceptible to vaginal infections.¹ 

Bacterial Vaginosis vs. Yeast Infection: What’s the Difference? 

Bacterial vaginosis after menopause and yeast infections after menopause are some of the most common issues affecting vaginal health, and both can be caused by an imbalance in the vaginal microbiome. But the microorganisms that cause them are different and require different treatment. 

Bacterial Vaginosis in Menopausal Women

Bacterial vaginosis is characterized by a decline in lactobacillus and an overgrowth of anaerobic bacteria, most commonly Gardnerella vaginalis. This bacterium is a normal part of the vaginal microbiome—it's only the overgrowth that causes the infection.² What does bacterial vaginosis feel like? Symptoms include vaginal itching, burning during urination, a strong, fishy odor, and a thin, white, gray, or greenish discharge—though not all women experience symptoms.  

Bacterial vaginosis is often treated with antibiotics, which may require a doctor’s appointment. It can also clear up on its own.³ Some women may choose or be recommended a probiotic as well that is formulated specifically for supporting the vaginal microbiome, to help maintain balance. 

What are Yeast Infections?

Yeast infections are caused not by an overgrowth of bacteria, but rather by an overgrowth of the fungus candida. Candida is naturally occurring in the vagina, but lactobacillus normally keeps too much of it from growing. But when lactobacillus levels decline, the vagina is more susceptible to candida overgrowth, causing symptoms like vaginal itching, swelling, burning or pain during sex, soreness, redness, and a potential vulvar rash, as well as a thick or clumpy white vaginal discharge. A healthcare provider can prescribe a prescription strength antifungal, but many women start with creams and suppositories that are available over the counter. Most yeast infections come from a specific kind of yeast called Candida albicans, but not all of them do. If symptoms persist, a lab test can help identify the type of candida and the best treatment for it.⁴ 

How Menopause Changes Vaginal Health 

Your vaginal microbiome changes throughout your whole life. There are links between the vaginal microbiome and everyday factors like hormonal birth control, sexual activity, smoking, diet, exercise, antibiotics, and menstruation. On top of those, perimenopause, menopause, and postmenopause can all come with their own changes to vaginal health.⁵ 

When your estrogen levels naturally decline during perimenopause, menopause, and postmenopause, your vaginal lactobacillus levels decline too, leaving you with less of their protective power. Declining estrogen also makes the vagina less acidic and can change the vagina on a cellular level too, contributing to vaginal atrophy, a chronic condition marked by the thinning of the internal (and occasionally external) tissues of the vagina. 

Bacterial Vaginosis After Menopause

An estimated one in three women will get bacterial vaginosis at some point in their lives.⁶ More research needs to be done on whether changes to the vaginal microbiome during perimenopause, menopause, and postmenopause make women more susceptible to this infection. Although lactobacillus levels do decline during this time, it hasn’t shown to necessarily go hand-in-hand with the growth of BV-associated microorganisms.⁷ 

That said, there are links between vaginal atrophy and bacterial vaginosis, since the less acidic environment in the vagina during this time can leave the vagina more vulnerable to the growth of bacteria.⁸ 

Yeast Infections After Menopause

Most women will get a yeast infection at some point in their lives, but the decrease of lactobacillus bacteria during menopause can encourage overgrowth of yeast in the vagina. Women who wear pads for urinary incontinence, another common symptom during this time, may also be more susceptible, thanks to decreased oxygen flow to the area, which can affect the vaginal microbiome.⁹ As women get older, they’re also more likely to develop diabetes or high blood sugar, which predisposes them to yeast infection after menopause.¹⁰ 

Other daily steps you can take to help prevent bacterial vaginosis and yeast infection after menopause or before, include:¹¹ 

•       Avoiding products that can disrupt the balance in the vaginal microbiome, like fragranced soaps and pads and vaginal douches and washes. 

•       Keeping soap outside your vagina. Your vagina is self-cleaning, so even when using non-fragranced products, you should only be washing your vulva, not the inside of your vagina. 

•       Keeping your genital area dry. Bacteria grows more easily in wet environments, so make sure to dry off thoroughly after showering and change out of wet bathing suits and sweaty clothes immediately. Choosing underwear with a cotton crotch can help keep the area dry too. 

Continuing or Recurring Symptoms? Talk to Your Healthcare Provider 

Keep in mind that bacterial vaginosis and yeast infections don’t always cause noticeable symptoms—and that symptoms like itching, odor, and “off” discharge can also be caused by some sexually transmitted infections, or a skin reaction to bath products.¹² If your symptoms aren’t going away or come back after treatment, it’s worth a chat with your doctor. 

Resources 

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770522/ 
2. https://www.ncbi.nlm.nih.gov/books/NBK459350/ 
3. https://my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis 
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151053/ 
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6743080/ 
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232816/ 
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130764/ 
8. https://www.healthcentral.com/slideshow/vaginal-infections-and-vaginal-atrophylink 
9. https://www.healthcentral.com/slideshow/vaginal-infections-and-vaginal-atrophylink
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130764/ 
11. https://www.nichd.nih.gov/health/topics/vaginitis/conditioninfo/prevention 
12. https://health.clevelandclinic.org/dont-assume-itch-yeast-infection/