Perimenopause is a phase of transition leading up to menopause, typically starting in a woman’s 40s, but it can begin earlier.
Significant hormonal changes mark it as the ovaries gradually produce less estrogen and progesterone.
These fluctuating hormone levels play a pivotal role in many physical and emotional changes during this period.
As estrogen levels decline, women may experience a range of symptoms. Some of the most common symptoms of perimenopause include:
- Hot flashes: These are feelings of heat, often accompanied by sweating, that can last for a few minutes to several minutes. They come on suddenly.
- Mood swings: Emotional fluctuations such as irritability, sadness, or anxiety, which are linked to hormonal changes.
- Vaginal dryness: Decreased estrogen levels can contribute to thinning and also dryness of vaginal tissues, causing discomfort and potential sexual difficulties.
- Irregular periods: The menstrual cycle becomes less predictable as hormone levels shift.
- Sleep disturbances: Many women experience insomnia or poor sleep quality due to hormonal fluctuations.
Can Perimenopause Cause BV? The Short Answer
Yes, the hormonal changes during perimenopause, particularly drops in estrogen levels, can lead to changes in vaginal health and vaginal flora, making women more susceptible to bacterial vaginosis (BV).
However, the full connection between perimenopause and BV requires further exploration, as other factors, such as immune system changes and vaginal pH shifts, also play a role.
Understanding Bacterial Vaginosis (BV)
Bacterial Vaginosis (BV) is a relatively common vaginal infection. It’s caused by an imbalance of the natural bacteria in the vaginal microbiome.
The vagina is home to a variety of bacteria, including Lactobacilli, which are considered “good” bacteria.
These bacteria help maintain a healthy vaginal environment by keeping the pH level slightly acidic, which prevents the overgrowth of harmful bacteria.
When the balance of bacteria is disrupted—typically when the number of harmful bacteria increases and the Lactobacilli decreases—BV can develop.
Common symptoms of BV include unusual vaginal discharge (often gray or white), a strong fishy odor, itching, and discomfort during intercourse or urination.
BV and Perimenopause
During perimenopause, hormonal fluctuations, especially a decrease in estrogen levels, can affect vaginal health.
Estrogen plays a big role in maintaining the vaginal environment by promoting the production of Lactobacilli, which helps keep harmful bacteria in check.
When estrogen levels drop, as they do during perimenopause, the vaginal tissues can become thinner, drier, and more prone to irritation.
In this environment, harmful bacteria are more likely to thrive, making BV more common during this transitional phase.
Additionally, lower estrogen levels can alter the vaginal pH, making it less acidic and more conducive to bacterial overgrowth.
As a result, women in perimenopause may find themselves more vulnerable to infections like BV due to these changes in their vaginal health.
Can Perimenopause Cause BV?
Hormonal Fluctuations and Vaginal Health
Estrogen, a key hormone in a woman’s body, plays a role in maintaining vaginal health.
One of its primary functions is to support the growth of Lactobacilli, the beneficial bacteria that make up the majority of the vaginal microbiome.
These good bacteria make lactic acid, which helps maintain an acidic vaginal environment. The acidic pH of the vagina works as a natural defense, preventing harmful bacteria from proliferating.
During perimenopause, estrogen levels fluctuate and gradually decline, leading to several changes in the vaginal environment.
As estrogen decreases, the number of Lactobacilli can diminish, weakening the protective barrier against harmful bacteria.
This reduction in protective bacteria can leave the vagina more susceptible to infections, which can include bacterial vaginosis (BV).
Without enough Lactobacilli to regulate pH and ward off harmful microbes, harmful bacteria are more likely to take over, leading to BV.
Changes in Vaginal pH
Estrogen also helps to maintain the vaginal pH at a slightly acidic level (typically around 3.8 to 4.5).
This acidic environment is crucial because it blocks the growth of harmful bacteria. One example is Gardnerella vaginalis, the bacteria often responsible for causing BV.
When estrogen levels decrease during perimenopause, the vaginal tissues may become less able to produce the protective acidic environment.
As a result, the vaginal pH can get more alkaline, which creates a more favorable environment for the overgrowth of BV-causing bacteria.
This shift in pH is one of the key factors that increases the risk of BV during perimenopause.
Weakened Immune System
Hormonal fluctuations during perimenopause don’t just affect vaginal health; they can also influence the immune system.
Lower estrogen levels can weaken the body’s ability to build an effective immune response, making it more challenging to fight off infections like BV.
Estrogen has been shown to support immune cell function, including the production of certain antibodies that help the body recognize and fight harmful pathogens.
When estrogen levels decline, the immune system can become less efficient. This leaves the body more vulnerable to infections, including BV.
These combined changes—declining estrogen levels, a shift in vaginal pH, and a weakened immune response—create an environment where BV-causing bacteria are more likely to thrive.
The immune system being weaker can also raise the risk of yeast infections and similar complications.
As a result, women going through perimenopause may experience an increased risk of developing BV.
Diagnosis of BV During Perimenopause
How BV is Diagnosed
Bacterial Vaginosis (BV) is most often diagnosed through a combination of methods that allow healthcare providers to accurately identify the condition:
- Pelvic Exam: During a pelvic exam, your healthcare provider visually inspects the vaginal area for signs of infection, such as abnormal discharge or irritation. The provider may also use a swab to collect a sample of vaginal discharge that can be analyzed further.
- pH Testing: Vaginal pH value is an important indicator of BV. A healthy vagina usually has a pH of around 3.8 to 4.5, which is acidic and helps maintain the balance of healthy bacteria. In cases of BV, the vaginal pH rises, often above 4.5, creating a more alkaline environment that supports the growth of harmful bacteria. pH testing is a simple and effective way to diagnose BV and determine if you have an elevated vaginal pH.
- Microscopy: After collecting a sample of vaginal discharge, the healthcare provider may examine it under a microscope to check for “clue cells” (vaginal cells covered with bacteria) and to assess the balance of good and harmful bacteria. This is a definitive way to confirm the presence of BV.
Challenges in Diagnosis During Perimenopause
Diagnosing BV in women going through perimenopause can be challenging due to the symptom overlap between perimenopausal changes and BV.
Many symptoms of BV—such as vaginal dryness, irritation, and discomfort during intercourse—can also be caused by the hormonal fluctuations that occur during perimenopause.
For example:
- Vaginal dryness: One of the most common perimenopause symptoms is vaginal dryness due to decreased estrogen levels, which can also contribute to discomfort and irritation that mimics BV symptoms. In postmenopausal women, vaginal atrophy may occur eventually.
- Increased vaginal discharge: Some women in perimenopause may experience changes in vaginal discharge due to hormonal shifts, making it hard to know the difference between normal changes and the signs of BV.
Because of these overlapping symptoms, it is crucial for women experiencing vaginal discomfort or unusual discharge to seek a professional diagnosis.
A healthcare provider will use the diagnostic methods mentioned above—pelvic exams, pH testing, and microscopy—to differentiate between perimenopausal changes and BV, ensuring the correct diagnosis and treatment.
Without professional evaluation, it can be challenging to distinguish whether the symptoms are related to perimenopause or a bacterial infection like BV.
Natural Supplements and Remedies for BV Related to Perimenopause
Oral Supplements for BV Relief During Perimenopause
Probiotics
- How and Why It Works: Probiotics, especially strains like Lactobacillus reuteri and Lactobacillus rhamnosus, play a crucial role in restoring balance to the vaginal microbiome by helping the growth of good bacteria. These beneficial bacteria help prevent the overgrowth of harmful bacteria, which is a key factor in the development of BV. By enhancing the population of Lactobacilli, probiotics play a role in the acidic pH of the vagina, creating an environment that resists bacterial infections.
- How to Use: Probiotic supplements typically contain between 1 to 10 billion CFUs (colony-forming units) per dose. For best results, take one capsule per day, though the exact dosage may vary depending on the specific product. You can also incorporate probiotics through food sources like yogurt, kefir, and fermented foods.
Vitamin C
- How and Why It Works: Vitamin C supports immune health and helps reduce inflammation. It also plays a role in regulating vaginal pH, which is important for maintaining a healthy vaginal environment. By lowering vaginal pH and promoting the production of collagen, Vitamin C may reduce the risk of infection and support overall vaginal health.
- How to Use: A typical daily dose of Vitamin C is 500–1,000 mg. You can take it through supplements or consume it naturally from foods such as citrus fruits, strawberries, bell peppers, and broccoli.
Maca Root
- How and Why It Works: Maca root is a well-known adaptogen that supports hormonal balance. By regulating estrogen and progesterone levels, maca root can alleviate many perimenopausal symptoms like hot flashes, mood swings, and vaginal dryness. As hormonal imbalances contribute to the development of BV, maca root may reduce the likelihood of experiencing BV related to these fluctuations.
- How to Use: It is typically recommended to take between 1,500 and 3,000 mg of maca root per day. The root comes in powder and capsule form, and it can be added to smoothies or taken as a supplement.
Evening Primrose Oil
- How and Why It Works: Evening primrose oil has essential fatty acids, particularly gamma-linolenic acid (GLA), which supports hormonal balance. It helps reduce vaginal dryness, a common symptom of perimenopause, which in turn can reduce the risk of BV. Vaginal dryness can make the tissues more susceptible to irritation and infection, so alleviating this symptom can play a significant role in preventing BV.
- How to Use: Evening primrose oil is commonly taken in capsule form, with typical daily dosages ranging from 500 mg to 1,000 mg. For better absorption, it is often recommended to take it in combination with other fatty acids (like omega-3s).
Cranberry Extract
- How and Why It Works: Cranberry extract can prevent urinary tract infections (UTIs), but it also helps maintain overall vaginal health. Cranberries contain proanthocyanidins, which inhibit harmful bacteria from adhering to the urinary tract walls and the vaginal lining, thus reducing bacterial overgrowth. Although more research is needed to confirm its effectiveness specifically for BV, cranberry extract may help maintain a balanced environment in the vaginal microbiome.
- How to Use: A common dose of cranberry extract is 500–1,000 mg daily. It can be taken as a supplement or consumed as unsweetened cranberry juice. To maximize its health benefits, ensure the product is free of added sugars.
Topical Supplements and Remedies for BV Relief During Perimenopause
Boric Acid
- How and Why It Works: Boric acid is a powerful antifungal and antimicrobial compound that can help restore the vagina’s natural pH balance. It works by rebalancing the vaginal environment, making it less hospitable to harmful bacteria and yeast that can cause infections like BV. Boric acid is particularly effective in treating recurrent BV by addressing the underlying pH imbalance and helping with an overall healthy vaginal microbiome.
- How to Use: For BV relief, insert a 600 mg boric acid capsule as vaginal suppositories once a day for 7–10 days. After this initial treatment, you can use the capsule a couple of times a week to maintain vaginal health and prevent BV recurrence.
Tea Tree Oil
- How and Why It Works: Tea tree oil is widely known for its potent antimicrobial properties, which make it effective in fighting off the bacteria responsible for BV. It can also help reduce inflammation, soothe irritation, and alleviate discomfort in the vaginal area. Tea tree oil’s natural antifungal and antibacterial effects make it a helpful remedy for BV.
- How to Use: Since tea tree oil is highly concentrated, it has to be diluted before applying to the skin. Mix around five drops of tea tree oil with a carrier oil (e.g., coconut oil), and use it in the vaginal area. It’s important to avoid direct application inside the vagina to prevent potential irritation. Do a patch test first to check for any allergic reactions to the oil before using it regularly.
Coconut Oil
- How and Why It Works: Coconut oil has both natural antifungal and antibacterial properties that help combat the bacteria causing BV. Additionally, it soothes irritated tissues, making it ideal for treating vaginal dryness and discomfort, which are common during perimenopause. Coconut oil can also improve skin hydration and reduce the pain associated with BV-related irritation.
- How to Use: Apply a small amount of organic, unrefined coconut oil directly to the vulva area to relieve dryness and irritation. It can be used regularly as part of your daily routine for ongoing comfort and to help maintain vaginal health. Always choose high-quality, organic coconut oil for the best results.
Prevention and Lifestyle Tips for Managing BV and Perimenopause
Maintaining Proper Vaginal Hygiene
- Avoid Douching and Scented Products: Douching and using scented soaps or sprays can disrupt the natural balance of bacteria in the vagina, often leading to an imbalance that may contribute to infections like BV. These can irritate the delicate vaginal tissues, potentially causing dryness, inflammation, and an increase in harmful bacteria. It’s best to avoid douching altogether, as it can wash away the good bacteria that naturally protect against infections.
- Use Mild, Fragrance-Free Soaps: To clean the external genital area, opt for mild, fragrance-free soaps to prevent irritation. Harsh chemicals and fragrances can disrupt the pH balance and contribute to discomfort, dryness, or infection. A gentle, pH-balanced cleanser is sufficient to maintain cleanliness without affecting the vaginal microflora.
Dietary Recommendations
- Include Fiber-Rich Foods: Including enough fiber in your diet helps regulate hormonal balance and supports digestive health, which is important during perimenopause. Fiber plays a role in maintaining stable blood sugar levels and promotes the healthy elimination of excess hormones, which can influence vaginal health.
- Incorporate Probiotics: Probiotic-rich foods (e.g., yogurt, kefir, and sauerkraut) help support a healthy gut and vaginal microbiome. Probiotics promote the growth of beneficial bacteria, like Lactobacilli, which help maintain an acidic vaginal pH, reducing the risk of BV.
- Healthy Fats for Hormonal Balance: Including healthy fats in what you eat can support hormone production and help alleviate symptoms of perimenopause. These fats are also crucial for maintaining the integrity of vaginal tissues, reducing dryness and discomfort.
- Stay Hydrated: Drinking plenty of water is essential for overall health and helps to maintain the mucous membranes in the body, including the vagina. Staying hydrated can reduce vaginal dryness, a common perimenopausal symptom that can increase the risk of BV.
Stress Reduction Techniques
- Meditation: Practicing mindfulness meditation reduces stress levels, which are known to exacerbate hormonal fluctuations and perimenopausal symptoms. Meditation encourages relaxation, calms the nervous system, and supports mental well-being, helping to stabilize hormone levels.
- Yoga: Yoga is another effective way to manage stress and improve overall health during perimenopause. It combines deep breathing, gentle movements, and mindfulness to help reduce tension, promote hormonal balance, and alleviate common symptoms like hot flashes, anxiety, and irritability. Certain poses may also improve circulation to the pelvic area, supporting vaginal health.
- Deep Breathing Exercises: Deep breathing exercises can quickly activate the body’s relaxation response, lowering stress hormones like cortisol. Controlled breathing helps regulate the autonomic nervous system and can alleviate anxiety, which often worsens during perimenopause. Incorporating deep breathing techniques into daily routines can help manage both emotional and physical stress.
By incorporating these prevention and lifestyle tips, you can help support vaginal health and manage symptoms of perimenopause.
Proper hygiene, a nutrient-dense diet, and effective stress management can all significantly reduce the risk of BV and promote overall well-being during this transition.
Conclusion–The Link Between Perimenopause and BV
During perimenopause, hormonal fluctuations, particularly the decline in estrogen levels, can significantly impact vaginal health, making women more susceptible to bacterial vaginosis (BV).
As estrogen decreases, the vaginal environment becomes more prone to pH imbalances, dryness, and a decrease in the healthy bacteria that protect against infections.
These changes increase the likelihood of developing BV.
However, by addressing these hormonal shifts through diet, lifestyle changes, and natural supplements, women can better manage their vaginal health and reduce the risk of BV.
Natural supplements and remedies, such as probiotics, boric acid, and coconut oil, offer valuable tools to manage BV during perimenopause.
These natural solutions can help restore balance to the vaginal microbiome, reduce irritation, and support overall well-being during this transitional phase.
While natural remedies can be highly beneficial, it’s essential to consult with a healthcare provider before starting any new supplement or treatment regimen.
A healthcare provider could recommend hormone replacement therapy or other conventional treatments as well.
By combining natural remedies with expert care, women can take control of their health, maintain a balanced vaginal environment, and alleviate the symptoms associated with both perimenopause and BV.
Additional Resources and Research
Mei, Zhaojun, and Dandan Li. “The Role of Probiotics in Vaginal Health.” Frontiers in Cellular and Infection Microbiology, vol. 12, 2022, p. 963868, https://doi.org/10.3389/fcimb.2022.963868. Accessed 13 Jan. 2025.
Krasnopolsky, Vladislav N., et al. “Efficacy of Vitamin C Vaginal Tablets As Prophylaxis for Recurrent Bacterial Vaginosis: A Randomised, Double-Blind, Placebo-Controlled Clinical Trial.” Journal of Clinical Medicine Research, vol. 5, no. 4, 2013, p. 309, https://doi.org/10.4021/jocmr1489w. Accessed 13 Jan. 2025.
Meissner, H O., et al. “Therapeutic Effects of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon) Used As a Non-Hormonal Alternative to HRT in Perimenopausal Women – Clinical Pilot Study.” International Journal of Biomedical Science: IJBS, vol. 2, no. 2, 2006, p. 143, https://pmc.ncbi.nlm.nih.gov/articles/PMC3614596/. Accessed 13 Jan. 2025.
Mahboubi, Mohaddese. “Evening Primrose (Oenothera Biennis) Oil in Management of Female Ailments.” Journal of Menopausal Medicine, vol. 25, no. 2, 2019, p. 74, https://doi.org/10.6118/jmm.18190. Accessed 13 Jan. 2025.
Othaim, Ayoub A., et al. “Impact of Cranberry Juice Consumption on Gut and Vaginal Microbiota in Postmenopausal Women.” Food Frontiers, vol. 2, no. 3, 2021, pp. 282-293, https://doi.org/10.1002/fft2.76. Accessed 13 Jan. 2025.
Powell, Anna, et al. “Clinicians’ Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis.” Sexually Transmitted Diseases, vol. 46, no. 12, 2019, p. 810, https://doi.org/10.1097/OLQ.0000000000001063. Accessed 13 Jan. 2025.
Hammer, K A., et al. “In Vitro Susceptibilities of Lactobacilli and Organisms Associated with Bacterial Vaginosis to Melaleuca Alternifolia (Tea Tree) Oil.” Antimicrobial Agents and Chemotherapy, vol. 43, no. 1, 1999, p. 196, https://doi.org/10.1128/aac.43.1.196. Accessed 13 Jan. 2025.
Albornoz, Marco A., et al. “Virgin Coconut Oil in Paste Form As Treatment for Dyspareunia and Vaginal Dryness in Patients With and Without Rheumatic Autoimmune Diseases: An Efficacy and Safety Assessment Pilot Study.” Cureus, vol. 15, no. 6, 2023, p. e40501, https://doi.org/10.7759/cureus.40501. Accessed 13 Jan. 2025.
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