How is Menopause impacting the Vaginal Microbiome: What Every Woman Should Know!
- Melody Bartlett
- May 15
- 4 min read
Menopause- a significant transition in a woman’s life and highlighted by a host of physiological changes driven largely by declining estrogen levels. While hot flashes, mood shifts, and bone health often take center stage in menopause discussions, a lesser-known but equally important area affected is the vaginal microbiome.
Emerging research reveals that menopause has profound effects on the vaginal ecosystem, which in turn can influence overall health, comfort, and even susceptibility to infection. Below I will discuss what exactly happens to the vaginal microbiome during menopause and how it makes women vulnerable to symptoms therefrom.
Understanding the Vaginal Microbiome
The vaginal microbiome is a delicate community of microorganisms—primarily bacteria—that live in the vagina. In premenopausal women, this ecosystem is usually dominated by Lactobacillus species, which play a crucial role in maintaining a low pH (typically below 4.5). This is because one of the products of their metabolism is lactic acid. This acidic environment helps inhibit the growth of harmful bacteria and protects against infections such as bacterial vaginosis (BV), yeast infections, and sexually transmitted infections (STIs).
How does a decline in estrogen contribute to a change in this acidic environment?
With the onset of menopause, estrogen levels decline sharply. This hormonal shift leads to several changes that disrupt the vaginal environment, starting with thinning of the vaginal epithelium. Estrogen promotes the thickening of the vaginal lining and the production of glycogen (natures pack of sugar!), which feeds beneficial Lactobacillus bacteria. Remember, Lactobacillus’ metabolic byproduct is lactic acid. So, if we reduce estrogen there is less glycogen, starving these protective microbes and subsequently lowering the amount of lactic acid produced in the vagina. As a result a drop in Lactobacillus occurs as their food source diminishes. Lactobacillus populations decline, leading to a rise in vaginal pH.
The rise in vaginal pH from acidic to basic increases microbial diversity!
You might be thinking “well, Melody, I thought microbial diversity is good? Isnt that all we hear about?!”. Well, while diversity is often a marker of health in the gut microbiome, in the vagina, higher diversity often signals dysbiosis. This state is associated with inflammation, discomfort, and greater susceptibility to infections.
So how does this higher pH and more diversity in the vagina affect my health?
The most discussed, and understandably so due to discomfort, is vaginal dryness and Irritation. The reduced estrogen and microbial imbalance contribute to vaginal atrophy. Which means the vaginal wall is physically becomes thinner due to a lack of the energy source (glycogen).
Similar to how someone in a coma for a long time or someone who suffers from malnutrition develop atrophy of the muscle; the same concept is happening in the vaginal wall. This leads to dryness, discomfort and is a common symptoms of genitourinary syndrome seen in menopause (GSM).
Increased risk of Infection is another symptom that occurs as the protective effect of Lactobacillus diminishes, leaving postmenopausal women more vulnerable to urinary tract infections (UTIs) and bacterial vaginosis.
Systemically, the impact is still emerging in the literature, however, some evidence suggests that vaginal dysbiosis might contribute to broader systemic inflammation. The risk of this is the potential implication in influencing conditions like cardiovascular disease and osteoporosis.
The Figure below demonstrates the dynamics of the vaginal epithelium as is relates to pH and its microbial dominance variability
Wu, S., Hugerth, L.W., Schuppe-Koistinen, I. et al. The right bug in the right place: opportunities for bacterial vaginosis treatment. npj Biofilms Microbiomes 8, 34 (2022). https://doi.org/10.1038/s41522-022-00295-y
So now that we understand whats happening in the vaginal environment let’s talk ACTION!What can actually be done to support vaginal health during or after menopause?
Fortunately, there are ways topical or systemic estrogen therapy can help restore vaginal epithelium and glycogen levels, promoting Lactobacillus growth. However, this is important to discuss with your primary care or ObGYN provider to ensure that there are not any other indications that would make this unfavorable for other reasons. Probiotic treatments, especially those containing vaginal-specific Lactobacillus strains, show promise in rebalancing the microbiome. Here at Brain and Body we offer top of the line, Microbiome Labs “Vaginal Balance” equip with strain specific, balance restoring Lactobacillus Bacteria and Cranberry! Lastly, lifestyle factors, such as maintaining a healthy diet and avoiding unnecessary antibiotics, can also help preserve microbial balance.
Menopause is a natural phase of life, but it doesn’t have to compromise comfort or quality of life. Understanding how menopause affects the vaginal microbiome gives women and their healthcare providers valuable tools to manage symptoms, reduce infection risk, and support long-term wellness. With growing awareness and continued research, the conversation around vaginal health is expanding—and it’s one that every woman deserves to be part of.
Resources:
Brotman RM. (2011). Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective. Journal of Clinical Investigation, 121(12), 4610–4617.
Santiago GL, et al. (2011). Longitudinal study of the vaginal microbiome during the menopause transition. BMC Microbiology, 11, 230.
Zhou X, et al. (2007). Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME Journal, 1, 121–133.
MacIntyre DA, et al. (2015). The vaginal microbiome during pregnancy and the postpartum period in a European population. Scientific Reports, 5, 8988.
Gliniewicz K, et al. (2019). Comparison of the vaginal microbiomes of premenopausal and postmenopausal women. Frontiers in Microbiology, 10, 193.
Borges S, et al. (2014). The role of lactobacilli and probiotics in maintaining vaginal health. Archives of Gynecology and Obstetrics, 289(3), 479–489.
The North American Menopause Society (NAMS). (2020). The 2020 genitourinary syndrome of menopause (GSM) practice guidelines.
https://www.menopause.org/docs/default-source/professional/gsm-guidelines
World Health Organization (WHO) – Reports on women's health and vaginal infections in older adults.
ACOG (American College of Obstetricians and Gynecologists). FAQs and guidance on GSM and hormone therapy.
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