Women's health
5 reasons the vaginal microbiome is key for midlife health
You may have heard about the gut microbiome, but did you know your vaginal health is just as reliant on a delicate balance of bacteria? As we age, the vaginal microbiome plays an increasingly essential role in protecting against infections, supporting hormonal health, and maintaining overall wellbeing.
For women in midlife, particularly those navigating perimenopause, menopause, and post-menopause, understanding this microbiome is more important than ever.
Fluctuating hormones, such as declining oestrogen levels, can disrupt the balance of bacteria in the vagina, making us more susceptible to infections, discomfort, and even affecting our general immunity.
What is the vaginal microbiome?
According to Karen Tang, MD, gynaecologist and author of It’s Not Hysteria: The Truth About Pelvic Pain, Period Problems, and Your Gynaecologic Health, the vaginal microbiome is the normal bacteria that lives in the vagina. These bacteria are critical for maintaining vaginal health.
“The bacteria of the microbiome are what ensure a healthy pH, and prevent infections such as yeast or bacterial vaginosis (BV),” she explains. “The most common class of bacteria in the microbiome are Lactobacilli, which produce lactic acid. Lactic acid is the reason that the normal vaginal pH is actually acidic, around 3.5-4.5 (the pH of water is 7).
“This acidic pH, as well as other factors produced by the microbiome, inhibit the growth of other organisms that can cause bothersome vaginal infections, but also more serious health risks such as pelvic inflammatory disease or even miscarriage and pre-term birth.”
The microbiome is essentially a complex ecosystem of different bacteria and yeast that exist in a delicate balance. Disruptions in that balance can lead to pelvic health issues.
Keeping the vaginal microbiome healthy
As much as we want to give a helping hand, leaving the vagina to do what it does best is usually the best route to go.
Karen reveals that there’s an expression that gynaecologists say all the time: ‘the vagina is a self-cleaning oven.’
“You don’t need to clean inside the vagina at all,” Karen says, “because the microbiome is keeping things healthy.”
According to Karen, soaps, douches and even washing with water inside the vagina, can kill or flush away the normal bacteria that is necessary for maintaining vaginal health, and increases the risk of infections and irritation.
“Only wash the vulva outside (the labia minora and majora), do not wash internally inside the vagina,” she advises.
How does oestrogen affect our microbiome?
Oestrogen wears many hats: it regulates the menstrual cycle, skin and mood, to name a few of its roles. It’s also important for maintaining the microbiome, which fluctuates with the menstrual cycle, as well as during pregnancy, and after menopause.
“Low oestrogen states such as menopause lead to fewer Lactobacilli and a higher vaginal pH, which can cause BV and irritation of the vagina, bladder, and urethra,” explains Karen.
How can a healthy biome prevent recurring UTIs?
If there weren’t already enough microbiomes to look after, there’s another to add to the list: the urinary microbiome. It’s closely associated with the vaginal microbiome, too.
“Lactobacillus is the most common bacteria type in the lower urinary tract (bladder and urethra),” Karen explains. “Disruptions in the urinary microbiome have been associated with symptoms such as urinary urgency and UTIs. It’s less clear whether maintaining the microbiome will help prevent recurrent UTIs. There’s less data on the urinary microbiome in general.
“But vaginal oestrogen treatment in post-menopausal women is definitely associated with a protective effect in decreasing recurrent UTIs. It can decrease the risk of UTI by up to 50%.”
How can we support vaginal health in midlife?
As we age, our oestrogen levels gradually decline. According to Karen, vaginal oestrogen is probably the most effective treatment for maintaining vaginal health in perimenopause and menopause.
“It is a low-risk treatment with minimal absorption into the rest of the body, so can even be used safely in most women with breast cancer (obviously, women with breast cancer should discuss with their oncologist),” she says.
“It helps to protect the tissue quality, elasticity, lubrication, as well as the microbiome of the vagina and lower urinary tract, prevents UTI’s, and can minimise vaginal infections and pain with sex.”
It’s important to remember that you don’t need special vaginal or feminine washes, douches or deodorants. “These products can actually harm your normal microbiome and increase the risk of vaginal infections and irritation,” she shares.
Words: Holly Treacy-West
