If you’ve ever experienced vaginal itching, burning, or irritation—or if you’ve noticed an unusual, foul-smelling discharge—your symptoms may point to a vaginal infection. While infections can be uncomfortable and frustrating, they are not uncommon— for example, up to 75% of women will experience one vaginal yeast infection in their lifetime, and 40-45% of women experience two or more.1
Women approaching menopause, in particular, may be at an increased risk for developing vaginitis. Two very common types of vaginal infections include yeast infections, which are triggered by an overgrowth of candida, a naturally-occurring fungus in the vagina, and bacterial vaginosis, or BV, which is caused by an imbalance of bacteria.2
Why Can Vaginal Infections Occur More Often in Menopause?
Estrogen plays an important role in promoting the growth of healthy organisms inside the vagina. Estrogen is a hormone that encourages “good” bacteria, called lactobacilli to flourish, but as estrogen levels begin to drop in perimenopause and continue to plummet in menopause, the vagina's pH may become imbalanced. This makes it easier for “bad” bacteria to multiply, and when lactobacilli become outnumbered, infection is more likely to occur.3
The good news is that even if your vaginal pH is off—or if bad bacteria growth goes into overdrive—there are several ways to fight infections. A number of antibiotic and antifungal medications are available (both over the counter and prescription), but if they don’t kick your vaginitis to the curb, you might consider a different type of supplemental treatment option: boric acid suppositories.
I Know What a Suppository is, But What Exactly is Boric Acid?
Boric acid is a water-soluble, naturally occurring compound that contains oxygen, boron, and hydrogen. It is a white substance that can be found in either powder or crystal form. Boric acid has been shown to have antifungal, antiviral, and antimicrobial properties, and has been used as a part of treatment regimens for conditions like diaper rash, athlete’s foot, and vaginal infections. Basically, boric acid can help in stopping bacterial and fungal growth.4
Boric acid isn’t a new option for supporting the treatment of vaginitis—physicians have recommended it for over one hundred years, and it has shown to be a safe and effective option often used in conjunction with prescription medications. Boric acid suppositories are easy to find and are available at many drugstores, as well as through online marketplaces, such as Amazon. They’re also inexpensive—often under $30, and you can buy them over-the-counter, so there’s no need for a prescription.5 If this is the first time you’re using boric acid, however, we’d recommend checking in with your healthcare provider first, just as a precaution.
Some healthcare providers may suggest boric acid to be used alongside prescription treatments for women suffering from vaginitis in menopause. “I frequently recommend boric acid suppositories for many of my patients who suffer with chronic and/or recurrent vaginal yeast infections,” says Dr. Alyssa Dweck, Bonafide’s Chief Medical Officer. “I typically recommend this as an adjunct to traditional treatment. Some patients will use boric acid suppositories as a standalone management option. It can also be used for prevention of recurrent infection alongside treatment, so, there are many acceptable regimens.” It’s important to note that some women may attempt the use of boric acid suppositories to cure certain vaginal infections, however, more research needs to be done to determine its true efficacy.
How Are Boric Acid Suppositories Used?
Boric acid suppositories are capsules that are inserted in the vagina, either manually by using your fingers, or with an applicator that may be included in some packages. If inserting digitally, remember to always wash your hands before and after use.
Suppositories are best used at the same time each day. Many women prefer to do so before going to bed at night, because as the suppository dissolves, a watery discharge may occur. Lying down after use can help to reduce annoying leakage that happens when you stand up (thanks, gravity!), and wearing a panty liner can keep your underwear dry and your body comfortable no matter when you choose to use the suppository.
Boric acid suppositories should only take a few minutes to dissolve once inserted into the vagina.6 In regard to dosage, “I usually recommend a 600 mg vaginal suppository each night for 3-7 days – each month, for 3-6 months, to manage recurrent infections, depending on the circumstance,” advises Dr. Dweck. “But some providers may also recommend a 14-day course or another alternate regimen.”
How Effective Are Boric Acid Suppositories?
A 2011 study by the National Institute of Health (NIH) examined 14 studies involving vaginal boric acid use (two randomized clinical trials, nine case series, and four case reports) and found a success rate between 40% and 100%. A second study from 2019 determined that boric acid suppositories were effective in helping to manage recurrent yeast infections with minimal side effects. These studies, plus the knowledge that women have been using boric acid to manage vaginitis for over a century, suggest a decent rate of effectiveness.7However, as mentioned earlier, we recommend checking in with your healthcare provider about any symptoms you’re experiencing first, before using boric acid, to ensure you’re using the right treatment.
What Are the Possible Side Effects of Boric Acid Suppositories?
Many medications, supplements, and treatment regimens include the possibility of side effects, so let’s look at how boric acid suppositories may affect some of the women who use them.” Most people tolerate boric acid without any problem; however, some are sensitive and need to discontinue use,” explains Dr. Dweck. And like most medications, there is always the possibility of one person not responding as well as they may have hoped. The most common side effects from using boric acid suppositories include:8
- Watery vaginal discharge
- Burning sensation
- Skin redness
If you experience any of these symptoms after starting a boric acid suppository regimen, discontinue use immediately and contact your healthcare provider.
What Precautions Should Be Taken When Using Boric Acid?
Sometimes you just don’t know how a new treatment plan will affect your body, which is why it’s always a good idea to talk to your healthcare provider before beginning any new medication or supplement. There are several circumstances under which boric acid suppositories should not be used, including in women who: 9
- Are pregnant or considering becoming pregnant
- Are currently breastfeeding
- Have open wounds, sores, or ulcers in the vulva/vagina
Be sure to also speak with your healthcare provider before use in the event you have a weakened immune system or have been diagnosed with diabetes, just as a precaution.10
If your healthcare provider feels you are a good candidate for trying boric acid suppositories during menopause, there are still some precautions to note. Dr. Dweck emphasizes that while boric acid suppositories are safe for vaginal use, they should NEVER be ingested. “To be clear, this includes avoiding any oral intake, even during oral/genital sexual activity,” she says. Vaginal intercourse after use may be ok; however, you or your partner may experience burning or irritation.11 We recommend checking with your provider if you have specific questions or concerns about use.
Currently, there are several social media trends targeting boric acid suppositories that are focused on their ability to support various facets of vaginal health, such as rebalancing pH levels after sex and improving vaginal taste and odor. Boric acid suppositories are NOT intended to address these issues, so please don’t attempt to copy the latest TikTok trend. Using boric acid suppositories on a regular basis can also actually strip away good bacteria from the vagina and end up exacerbating the very problem it is intended to solve.12
While vaginal infections are unpleasant, they can be treated with proper care. If over-the-counter medications aren’t working for you, consider asking your healthcare provider if using boric acid suppositories as a supportive addition to your regimen might be helpful.