Are There Side Effects of Using Vaginal Probiotics During Perimenopause?

During perimenopause, your hormones start to fluctuate – as this is considered the first stage of the menopause transition. These hormone fluctuations cause a plethora of well-documented symptoms, like irregular periods, mood swings, hot flashes, and vaginal dryness. Less talked about are the changes transitioning through menopause can cause to the vaginal microbiome.

Like your gut, your vagina has a unique microbiome that can become imbalanced with an overgrowth of unhealthy bacteria, fungi, or other microorganisms. To help support a better balance, some women may consider turning to vaginal probiotics to improve their vaginal health. If you’re thinking about joining their ranks but are concerned about any potential risks or side effects of using vaginal probiotics, keep on reading.

In this article, we’ll explain what the vaginal microbiome is, and how it can be affected by the hormonal changes experienced during perimenopause and menopause. We’ll also address what vaginal probiotics are and how they may work to help support optimum levels of vaginal health and balance within the microbiome.

What is the Vaginal Microbiome?

Just like your gut, your vaginal microbiome is an ecosystem filled with healthy bacteria and other microorganisms. Unlike your gut, however, which contains 300-500 bacterial species, your vaginal microbiome has around 50+ bacterial species.^1,2

Since it’s sensitive to the effects of the female sex hormones estrogen and progesterone, the vaginal microbiome undergoes shifts and changes due to hormonal fluctuations starting from your pre-pubescent years all the way through to postmenopause.³

Your vaginal microbiome is at its healthiest when it contains more Lactobacillus strains than any other bacterium. These strains of bacteria work to keep your vaginal pH levels in the acidic range, which helps to protect it from harmful bacteria and yeast that can cause symptoms such as discharge, itching and odor, and outright infections, such as bacterial vaginosis and candidiasis.⁴

The main strains of beneficial vaginal Lactobacillus include: L. acidophilus, L. rhamnosus, gasseri, L. jensenii, L. reuteri, and L. crispatus.⁵

Perimenopause, Menopause, and the Vaginal Microbiome

During perimenopause, estrogen and progesterone production becomes erratic and eventually declines significantly during menopause. This shift in hormones affects ovulation and causes your periods to become irregular. It also causes other symptoms, as noted above, like mood changes, changes in sexual desire, hot flashes, and night sweats.⁶

In addition to these well-known symptoms, the hormonal changes experienced during perimenopause into menopause can also impact the balance of bacteria residing within the vaginal microbiome.

When your ovaries produce less estrogen, the pH balance of the vagina becomes less acidic, and more basic. This often results in reduced amounts of Lactobacillus production.⁷

Lactobacillus needs optimal amounts of estrogen, or it can’t maintain dominance within the vaginal microbiome. Without enough estrogen, Lactobacillus levels go down, and harmful bacteria are better able to multiply. This makes your vagina more vulnerable to uncomfortable symptoms and to yeast and other types of infections.⁸

How Can Vaginal Probiotics Support Vaginal Health During the Menopausal Transition?

Probiotics for vaginal health have not been as well researched as probiotics for gut health. Even so, some clinical studies suggest their effectiveness for supporting Lactobacillus and potentially reducing the risk for certain vaginal infections.⁹ There’s even some evidence that indicates that Lactobacillus may activate the immune system to inhibit cervical cancer progression¹⁰ – more research is needed to further validate this, however.   

Women’s vaginal probiotics are available as oral capsules and as vaginal suppositories. To be effective for supporting an optimal vaginal pH, the probiotics you choose should contain one or more live, active Lactobacillus strains such as L. rhamnosus, L. reuteri and L. acidophilus.¹¹

Many probiotics contain between 1 to 10 billion colony forming units or CFUs – when choosing a probiotic, be sure to look for the number of CFUs at the end of the product’s shelf life; be sure to note the time of manufacturing and expiration/best by dates, as some CFUs may die during their shelf life.¹²

Of course, not all probiotics are created equal. It’s a good idea to always look for probiotics that come from a trusted manufacturer with a solid track record for transparency. Consider those who utilize stringent safety and quality guidelines, as well as run appropriate efficacy studies prior to the production of their products. Make sure to also always check the expiration date on any probiotic product before you use it. Expired or opened goods should be tossed, to avoid exposure to mold, or other negative substances.

Side Effects of Vaginal Probiotics

There are no known risks to using vaginal probiotics in healthy people.¹³ To be on the safe side, it’s always a good idea to talk with your healthcare provider if you’re grappling with a severe illness or are immunocompromised – or even if you’ve just never used probiotics before, to ensure they’re right for you.

Some people may experience negative side effects from probiotics, like an upset stomach, diarrhea, and/or gas.¹⁴

While uncommon, it’s possible to be allergic to Lactobacillus, and to other ingredients contained in certain vaginal probiotics – allergies could lead to negative side effects associated with the use of these types of products.

You may be more likely to be allergic or sensitive to vaginal probiotics that contain Lactobacillus if you have an allergy to milk products, or yeast.¹⁵ If so, hives or a skin rash may occur when you use them.

You may also have a more severe allergic reaction that causes symptoms like trouble breathing or a fast heartbeat. Severe allergic symptoms can indicate a medical emergency and should always be addressed promptly by a healthcare professional. This is also why it’s imperative to check with your healthcare provider first before incorporating any new products or supplements into your daily routine – just as an added precaution. 

When to Talk to a Healthcare Provider

Menopause may cause notable changes to the vagina in many women. These can include shifts in vaginal discharge that may concern or even alarm you. It’s possible for your vaginal discharge to take on a brownish tint, or suddenly have a different scent. The texture may also change, becoming thicker, or clumpier.¹⁶ While disconcerting, these changes are not uncommon and most likely not a cause for alarm. If you experience any of the symptoms mentioned below, however, in conjunction with a change in vaginal discharge, you may want to check in with your healthcare provider.

Vaginal infections can alter the texture, scent, and color of vaginal discharge. If your discharge is accompanied by any of these symptoms, it’s a good idea to see your healthcare provider for a proper diagnosis and treatment:¹⁷

• Itching
• Burning
• Swelling
• Redness
• Fishy smell
• Yellow color
• Cottage-cheese-like consistency
• Bleeding

As we mentioned, hormonal changes experienced during menopause that alter the vaginal pH may leave you vulnerable to vaginal infections that can come along with uncomfortable symptoms. If you experience recurrent infections that don’t respond easily to treatment, you should also let your healthcare provider know.

In many instances, vaginal probiotics may help you to maintain a balanced microbiome and support your overall vaginal health. However, it’s never a bad idea to have a healthcare provider weigh-in to rule out potential infections.

Resources

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983973/#:~:text=Within%20the%20human%20gastrointestinal%20microbiota,million%20genes%20(the%20microbiome).
2. https://health.clevelandclinic.org/probiotics-for-vaginal-health
3. https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.819958/full
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058480/
5. https://health.clevelandclinic.org/probiotics-for-vaginal-health
6. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666#:~:text=The%20level%20of%20estrogen%20%E2%80%94%20the,release%20an%20egg%20(ovulate)
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047399/#:~:text=Increased%20vaginal%20pH%20caused%20by,of%20genitourinary%20syndrome%20of%20menopause.
8. https://www.frontiersin.org/articles/10.3389/fmed.2018.00181/full
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662373
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366906/
11. https://www.healthline.com/health/vaginal-health/probiotic-vaginal-health#good-probiotic-strains
12. https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional
13. https://health.clevelandclinic.org/probiotics-for-vaginal-health
14. https://www.mountsinai.org/health-library/supplement/lactobacillus-acidophilus
15. https://www.consumerlab.com/answers/i-developed-a-rash-soon-after-starting-a-probiotic-is-it-possible-to-be-allergic-to-probiotics/probiotic-allergic-reaction-rash/
16. https://www.healthline.com/health/menopause/perimenopause-discharge#how-discharge-changes
17. https://www.acog.org/womens-health/experts-and-stories/the-latest/think-you-have-a-vaginal-infection-heres-what-you-need-to-know