Once we’re in menopause - haven’t had a period in a year - the vaginal microbiome has changed to reflect low oestrogen levels. Menopause usually appears over a few years between the ages of 45 and 55, after a middle stage called peri-menopause. Menopause may also be induced, for example, after some cancers and surgeries.

Peri-menopause can bring its own set of microbial challenges due to fluctuating hormones, but once we’ve stopped having periods completely, the microbiome shifts again and tends to stay stable.

The impact of oestrogen on the vaginal microbiome

Oestrogen stimulates a special sugar in vaginal cells called glycogen. Glycogen is a food source for some microbes, in particular protective lactobacilli that are abundant during menstruating years.

Once oestrogen has declined, it stays slow for the rest of our lives, and this food source for lactobacilli in the vagina disappears. Vaginal cells have a lot of oestrogen receptors, keeping vaginal cells plump and juicy. This loss of oestrogen may result in vaginal symptoms such as dryness, irritation and thin tissue, as well as changes to the number and types of bacteria present.

A menopausal vagina typically has low levels of all bacteria, not just lactobacilli. This lack of protective flora may result in the overgrowth of pathogens that can cause bacterial vaginosis or aerobic vaginitis, along with sometimes an increase in urinary tract infections.

The pH of a menopausal vagina will also increase, and the actual number may vary depending on which microbes are present. The pH tends to be around 5.5.

Microbiome problems in menopause - and how to solve them

Some people will find that their vagina is not happy after menopause, and frequent irritations and flora imbalances can result. The solutions usually centre around restoring some oestrogen locally, which can be achieved using naturopathic or hormone applications.

Oestrogen in the vagina helps it become a little more robust and can soothe and moisturise. Some glycogen becomes available to any remaining or introduced lactobacilli (via probiotics), which can support a small but mighty colony that protects the vagina from pathogens.

These topical applications have an oestrogenic effect on vaginal cells, thickening and strengthening tissue. Each person will respond differently to these applications, so trying several options may be required to get the best results or avoid side effects.

Hormone treatments in menopause

In Australia, hormone replacement or therapy tends to be only topical applications in menopause, as systemic (oral or patches) hormones are usually not considered medically necessary. In the United States, bioidentical hormone replacement into menopausal years is common. Hormone therapy is prescribed by doctors.

Plant oestrogens for a gentle alternative

There are other ways to gently increase levels of hormones using phyto-oestrogens found in food and herbs. The impacts aren’t as dramatic as hormone therapy, as phyto-oestrogens are about 300 times weaker than human oestrogens.

These phyto-oestrogens fit into oestrogen receptors, which has a cascade effect similar to regular oestrogen, including positive impacts on vaginal tissue. See a naturopath or herbalist for advice.

The adrenal glands produce oestrogens in menopause

An often overlooked aspect of menopausal oestrogen levels is the adrenal glands. The adrenal glands produce hormones that regulate several important functions, including metabolism, the immune system, and our stress response.

The adrenals produce a substance that can be converted into oestrogen in menopause. Having healthy adrenal function, therefore, becomes incredibly important as we head into menopause.

If you’ve been under chronic stress, have been unwell, aren’t sleeping through the night or have too much on your plate, your adrenals may need a helping hand.

A naturopath or herbalist is able to help you safely support an increase in available hormones with foods and herbs to support your adrenal glands, working towards a reduction in any uncomfortable symptoms of menopause.

Getting help for vaginal microbiome problems in menopause

Microbiome imbalances aren’t the only issue that can occur in menopause, but these symptoms are a sign that your system needs support. That might be the regular use of a simple fennel pessary/suppository, oestrogen cream, or treatment for overworked adrenals. Appropriate treatment depends on your symptoms.

It’s usually a solid strategy to start with the topical vaginal treatments and work your way up to more comprehensive care as needed. Find a qualified, experienced practitioner to support your journey and know that many of the problems women have learnt to suck up and tolerate can be improved with the right help, sometimes dramatically.