You may never have heard of the vaginal microbiome.
It’s an ecosystem of microorganisms that plays a role in women’s reproductive health. A healthy vaginal microbiome is largely composed of Lactobacillus, microorganisms that help maintain a pH around 4.5.
“It protects against pathogens or things that can cause infections by keeping it in an acidic environment,” Dr. Sadaf Lodhi, board-certified OB-GYN and sex counselor, tells Flow Space. “We need this microbiome to create this healthy community, so our bodies are not prone to infection.”
The vaginal microbiome maintains homeostasis, a self-regulatory process that keeps the reproductive system functioning properly.
What happens to the vaginal microbiome in midlife?
When women reach midlife and estrogen levels decrease, the vaginal microbiome’s pH can shift out of the homeostatic range. A decrease in estrogen can reduce the amount of lactobacilli, which convert glycogen into lactic acid, Lodhi explains. “When that’s disrupted, the things that can happen are wide-ranging,” Lodhi says. “If you are in a state where there is low estrogen, then that can absolutely throw off your vaginal microbiome.”
For one, women are more prone to experience conditions like bacterial vaginosis, an infection associated with reduced lactobacilli in the vagina that can lead to abnormal discharge. An irregular pH of the vaginal microbiome is also associated with an increased risk of catching sexually transmitted diseases like trichomoniasis, HPV, and HIV.
Of note, men also play a role in the incidence of bacterial vaginosis by carrying and spreading it. New research published in The New England Journal of Medicine last year showed that treating men for bacterial infection reduced the recurrence of bacterial vaginosis in women.
Should you check your vaginal microbiome?
A vaginal microbiome test is not a standard practice and is not necessarily needed, Lodhi says. If a woman has the symptoms of bacterial vaginosis, for example, Lodhi would do a culture test and then prescribe vaginal estrogen. Women in menopause with lower estrogen levels are also likely to have a higher pH, she adds.
However, more data may prove helpful. Evvy, a women’s health company, has a vaginal microbiome at-home test, and members receive a clinical review of the results. The company claims to help members “discover how treatments and behaviors affect your microbiome.”
How do you keep a healthy vaginal microbiome?
For women in midlife, vaginal estrogen, like in the form of a cream, is one of the most effective treatments for vaginal changes in midlife to keep your vaginal microbiome healthy, Lodhi says.
“You want to prevent those recurring UTIs. You want to prevent that overactive bladder. You want to maintain that vaginal pH, so you’re not susceptible to all of those infections that can happen when the pH is off,” she says.
Additionally, diversifying your gut microbiome by eating fermented foods like kimchi and sauerkraut also helps keep the vaginal microbiome healthy.
Also, you can boost lactobacilli in the vagina by prioritizing probiotic intake. Lodhi says it’s most important to prioritize probiotics for those on an antibiotic to help maintain homeostasis.
The bottom line is that the vaginal microbiome plays a role in women’s whole health — largely under the radar. It’s why you don’t recognize this complex system at work until something is off balance.
“The vagina is a self-cleaning organ. It takes care of itself. We have this whole vaginal microbiome in there to protect it from infection, to protect it from overgrowth of bacteria,” Lodhi says. “It’s really fighting in your defense.”
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