Bacterial vaginosis during and after menopause

Bacterial vaginosis (BV) is still a subject of great uncertainty, particularly among postmenopausal women, i.e. women who have passed the menopause. Bacterial vaginosis is most common in women of childbearing age, but both menopausal and postmenopausal women can be affected. Bacterial vaginosis is a common vaginal infection that occurs when there is an imbalance in the natural bacteria in the vagina. This imbalance causes the "good" bacteria (lactobacilli) to decrease, while the "bad" bacteria (anaerobic bacteria) increase. As a result, the pH value in the vagina increases and one of the characteristic symptoms is a strong fishy odour. However, the symptoms may be slightly different in post-menopausal women than in younger women. 

WHY POSTMENOPAUSAL WOMEN SUFFER FROM BACTERIAL VAGINOSIS 

The female body undergoes significant hormonal changes after menopause. One of the changes that is most noticeable is the decline in oestrogen levels. Estrogen plays an important role in maintaining a healthy vaginal environment by stimulating the production of glycogen in vaginal epithelial cells. Glycogen is converted by lactobacilli into lactic acid, which helps keep the pH of the vagina low (acidic), normally between 3.8 and 4.5. 

As estrogen levels drop during and after menopause, glycogen production decreases, leading to fewer lactobacilli and a higher vaginal pH. This more alkaline pH makes it easier for harmful bacteria to grow, increasing the risk of bacterial vaginosis. In addition, drier mucous membranes, which are common after menopause, can make the vagina more susceptible to infections such as bacterial vaginosis. 

VAGIVITAL ACTIVE GEL FOR DRY MUCOUS MEMBRANES 

VagiVital AktivGel is a non-sticky vaginal gel that has been studied at Swedish university hospitals. The results show that VagiVital AktivGel reduces symptoms of vaginal dryness, including itching, irritation and pain during intercourse and urination, and improves the management of urge incontinence. 

Buy VagiVital AktivGel here!


RESEARCH ON PH CHANGES AND BV IN POSTMENOPAUSAL WOMEN 

Research has shown clear links between menopause, changes in vaginal pH and the incidence of bacterial vaginosis. A study published in the journal Menopause found that postmenopausal women often have a vaginal pH of over 4.5, which is significantly higher than the acidic pH common in pre-menopausal women. The study also showed that the reduced amount of lactobacilli in postmenopausal women contributes to this pH increase and thus to an increased risk of bacterial vaginosis. 

Another study published in the Journal of Lower Genital Tract Disease investigated the prevalence of bacterial vaginosis in postmenopausal women and found that up to 30% of women in this group experienced symptoms of BV. The most common symptoms in these women were vaginal dryness, irritation and an unpleasant odour, rather than the classic fishy smell often associated with BV in younger women. 

Read more about what a healthy abdomen should smell like here! 


SYMPTOMS OF BACTERIAL VAGINOSIS IN POSTMENOPAUSAL WOMEN 

Post-menopausal women may have different symptoms of bacterial vaginosis than younger women. This is mainly due to hormonal changes that occur during and after menopause. Lower oestrogen levels affect the vaginal environment and can cause some symptoms to become less apparent. 

Estrogen production decreases significantly after menopause, leading to a thinner and drier vaginal mucosa. This change can affect the production of glycogen, which is an important food source for lactobacilli (the good bacteria). When lactobacilli are reduced, the pH of the vagina increases, making it easier for harmful bacteria to grow and cause bacterial vaginosis. 

The typical fishy odour often associated with bacterial vaginosis is caused by volatile amines produced by anaerobic bacteria in an estrogen-stimulated environment. During the menopause, these bacteria and their activity can decrease, so the characteristic fishy odour is not always as noticeable. 

COMMON SYMPTOMS IN WOMEN AFTER MENOPAUSE 

🌸 Unpleasant odour: Although the typical fish smell is not always present, there may still be an unpleasant odour reminiscent of other smells, such as a "fart". 

🌸 Thin, grey-white discharge: This is a common sign of bacterial vaginosis, even in post-menopausal women. 

🌸 Vaginal irritation or itching: Dryness and thinning mucous membranes can make the genital area more sensitive to irritation and itching. 

DIAGNOSING BV WITH VAGIVITAL VS SELF-TEST 

VagiVital VS Self-test for bacterial vaginosis diagnoses bacterial vaginosis with 92% accuracy. The high accuracy is due to the fact that the VS Self Test not only measures pH, but also the vaginal fluid's buffering capacity, i.e. the vaginal fluid's ability to resist changes in pH. A good buffering capacity means that the vaginal fluid can effectively counteract sudden pH changes, which is important for maintaining a healthy vaginal environment.  

A stable pH level in the vagina is crucial for preventing infections such as bacterial vaginosis. Normally, the vagina has an acidic pH, which is unfavourable for many harmful bacteria and fungi. If the pH level increases (becomes less acidic) due to reduced buffering capacity, this can create an environment where harmful bacteria thrive, which can lead to infections and unpleasant symptoms. Because the VS Self-test also measures the buffering capacity of the discharge, it can also include women with bacterial vaginosis who still have a normal pH. A standard pH test for bacterial vaginosis is only 78% accurate, making the VagiVital VS Self-test superior. However, in post-menopausal women, the vaginal pH can be elevated, which can give a false positive result with both the VS Self Test and a traditional pH test. 

Read more about VS Self-test for bacterial vaginosis here!   


DIAGNOSING BV WITH A GYNAECOLOGIST 

In order for a gynaecologist to make a diagnosis of bacterial vaginosis, three out of four criteria must be met: 

  1. A whiff test: A sample of vaginal secretion is taken and a drop of potassium hydroxide is added, which increases the pH value and, in the case of bacterial vaginosis, produces the typical fishy odour.
  2. Examination of discharge under a microscope.
  3. pH test of vaginal discharge: A pH above 4.5 may indicate bacterial vaginosis, but for post-menopausal women it can give a false positive result.
  4. Examination of the colour and consistency of the discharge 

TREATMENT OF BACTERIAL VAGINOSIS WITH ANTIBIOTICS 

Bacterial vaginosis has traditionally been treated with antibiotics, but this can disrupt the entire vaginal flora and lead to other problems. Antibiotics are effective against bacterial infections, but they also affect the body's favourable bacterial flora, including lactobacilli in the vagina. The beneficial lactobacilli are particularly important because they maintain an acidic pH in the vagina and protect against harmful organisms. When antibiotics reduce the number of lactobacilli, the pH can increase, creating a favourable environment for infections to grow unchecked. 


DRY MUCOUS MEMBRANES CAUSE PROBLEMS  

Dry mucous membranes are a common problem, especially in postmenopausal women, and can lead to a range of uncomfortable and sometimes painful symptoms, such as 

🌸 Small sores and cracks: Dry mucous membranes can develop small sores or cracks, allowing bacteria to enter and cause infections. 

🌸 Urinary tract infections: Dryness can also lead to an increased risk of urinary tract infections, as bacteria can more easily spread to the urinary tract. 

🌸 Pain during sexual intercourse: Dry and sensitive mucous membranes can make sexual intercourse painful, negatively affecting quality of life and sexual health. 

🌸 Pain when urinating: Due to dry and irritated mucous membranes, urination can become painful and uncomfortable. 

🌸 Urinary urgency: Vaginal dryness can also affect the urinary tract and lead to frequent urinary urgency. This can be very uncomfortable and affect daily activities. 

Dry mucous membranes also make them thinner and more vulnerable, which can make it easier for harmful bacteria to take over. By using VagiVital AktivGel you can moisturise and strengthen your mucous membranes, helping to prevent and alleviate these problems. 

Take care of yourself & Stay Pussytive ❤️ 

/Fanny Falkman Grinndal 
Business Manager Nordics 
Peptonic Medical AB 
fanny.falkman-grinndal@peptonicmedical.se