What Is a Vaginal Probiotic and What Are the Benefits During Menopause?
Written by Mallory Junggren
Gut probiotics have been the subject of countless scientific studies, supporting their benefits when it comes to everything from constipation and acid reflux to Alzheimer’s and migraines.1 Made of beneficial bacteria that naturally live in the body, gut probiotics work their magic in the gut microbiome, the gut’s ecosystem of trillions of bacteria, fungi, viruses, and protozoa.
But your gut isn’t the only part of your body that has its own microbiome. Your vagina does as well—and it too can benefit from a probiotic.
What Are Vaginal Probiotics?
Vaginal probiotics are probiotics for vaginal health. Your vagina requires a different balance of bacteria than other parts of your body. Take the gut, for example—it works best when the bacteria in its microbiome are diverse. An optimal vaginal microbiome, however, is made up of mostly lactobacillus bacteria,2 a single genus of bacteria that creates a protective environment. But 27% of women don’t have this lactobacillus dominance.3 Low lactobacillus leaves the vagina more susceptible to yeast infections, bacterial vaginosis, and related symptoms like odor, itching, and discharge.4
Benefits of Vaginal Probiotics During Menopause
A lot of factors can disturb the vaginal microbiome, including sex, smoking, hormonal birth control, diet, and stress. Most women will get a yeast infection at some point in their lives,5 and about a third will experience bacterial vaginosis,6 both of which can create symptoms like itching, burning, odor, and discharge.
You’re even more susceptible to vaginal infection in perimenopause and beyond, thanks to diminishing estrogen production. Research shows that before entering menopause, estrogen promotes colonization of the essential lactobacillus bacteria in the vagina.7 The bacteria keeps the vagina’s pH level low, preventing pathogens from causing infections. Decreased estrogen during menopause depletes lactobacillus bacteria and increases vaginal pH—the prime environment for harmful microorganisms that cause bacterial vaginosis and its symptoms.8
The good news is that you’re not stuck with an imbalanced vaginal microbiome when you reach menopause—and increasing your estrogen levels (like hormone replacement therapy would do) isn’t the only way to achieve balance. A vaginal probiotic with live, active lactobacillus strains helps balance and maintain a healthy vaginal microbiome, promoting the proliferation of beneficial microorganisms, lowering vaginal pH and preventing vaginal infections.9
Who Can Benefit From Vaginal Probiotics
A vaginal probiotic is most beneficial for women who have persistent, recurrent yeast infections, bacterial vaginosis, or their symptoms, as well as women who are menopausal. If you have risk factors for vaginal symptoms, like smoking or stress, a vaginal probiotic may have some proactive benefits too. If you’re taking antibiotics, a vaginal probiotic can actually counteract their negative effect on your vaginal microbiome. (Just make sure you take them at least four hours apart. Since antibiotics affect gut bacteria, they can get in the way of your probiotics working properly.)10
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How to Choose a Vaginal Probiotic
Not all vaginal probiotics for menopause are created equal.
First, make sure it contains a strain of lactobacillus. Lactobacillus acidophilus is the most researched strain of probiotics for vaginal health. Two other strains that experts believe are beneficial are lactobacillus rhamnosus and lactobacillus reuteri.11
Look into what else is in the ingredients list. Some, like lactoferrin, can assist probiotics by creating a protective biofilm in the vaginal microbiome and creating lactic acid, helping to maintain a healthy pH. Even manufacturing processes or improper packaging can damage the live bacteria, rendering the probiotic useless, so looking into a company’s reputation and manufacturing process is a good idea too.
Choose the best method for you. Probiotics for vaginal health come in pill form and as vaginal inserts, and both are effective. Consider what works for your routine and any other oral or intravaginal medications you’re using. “Many of my patients prefer the oral route for a probiotic since they may already be taking an antifungal, antibacterial, estrogen product or nonhormonal moisturizer vaginally,” says Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer at Bonafide.
Check the dosage. You’ll see benefits with anything from one or two billion colony forming units (CFUs, a unit used to estimate the number of live bacteria inside a specific supplement12), all the way up to 20 billion. You may notice that refrigeration-required probiotics tend to have a very high CFU count—that’s to protect the live bacteria from your stomach acid as it makes its way to your small intestine. Live bacteria can also be protected through encapsulation methods or coatings, so probiotics that don’t require refrigeration don’t require such a high CPU.13
When in Doubt, Ask Your Doctor
Although vaginal probiotics have been researched and found safe and effective, it’s never a bad idea to check with your doctor before adding a new supplement or medication. Your primary care doctor or OBGYN will be able to make a recommendation factoring in any medications you already take, health conditions, and your symptoms.
But if you're prone to uncomfortable symptoms and your doctor thinks you can give a probiotic geared toward vaginal health a try, it may just be the key that unlocks long-term relief.