Perimenopause is a natural transition for women to menopause. This phase involves bodily changes as the reproductive system gradually winds down. Bacterial Vaginosis (BV) is a prevalent vaginal infection. This article explores the relationship between perimenopause and BV, explaining how physiological changes during this transition may increase the likelihood of developing this common infection.
How Perimenopause Affects Vaginal Balance
Perimenopause brings about significant physiological changes, primarily driven by declining estrogen levels. Estrogen plays a role in maintaining the vaginal environment, influencing the thickness and elasticity of vaginal walls and the production of glycogen. As estrogen levels decrease, these vaginal tissues can become thinner, drier, and less elastic, which can lead to discomfort.
The reduction in estrogen directly impacts the vaginal microbiome. A healthy vaginal environment is dominated by beneficial Lactobacillus bacteria, which produce lactic acid. This lactic acid helps maintain an acidic vaginal pH (between 3.5 and 4.5), creating an environment that discourages harmful bacteria.
During perimenopause, the decline in estrogen leads to a decrease in glycogen content in vaginal cells, which is the primary food source for Lactobacillus bacteria. As Lactobacillus populations diminish, the production of lactic acid decreases, causing the vaginal pH to become less acidic and more alkaline, often rising above 4.5.
This shift in vaginal pH and reduced Lactobacillus create a less protective environment. This allows for an overgrowth of other bacteria, particularly anaerobic bacteria, associated with Bacterial Vaginosis. This imbalance makes the vagina more susceptible to infections like BV, linking perimenopausal hormonal changes to an increased risk.
Identifying Bacterial Vaginosis
Bacterial Vaginosis often presents with noticeable signs and symptoms, though some individuals may not experience any. A common indicator is a thin, white or gray vaginal discharge, which might also appear greenish.
A distinct “fishy” odor from the vagina is another characteristic symptom, often becoming more noticeable after sexual activity or during menstruation. In some cases, individuals might experience vaginal itching or irritation. Burning sensations during urination can also occur.
The intensity of these symptoms can vary widely among individuals. Approximately half of those with BV may not report any symptoms. Because some symptoms can overlap with other vaginal conditions, proper medical evaluation is important for an accurate diagnosis.
Diagnosing and Treating Bacterial Vaginosis
Healthcare professionals diagnose Bacterial Vaginosis through a combination of methods. The process often begins with a medical history review, including any past vaginal infections. A pelvic examination allows the provider to visually assess the vagina for signs of infection, such as abnormal discharge.
A vaginal swab is commonly taken to collect a sample of vaginal discharge for microscopic examination. Under a microscope, the presence of “clue cells”—vaginal cells covered in bacteria—can indicate BV. Additionally, the vaginal pH can be tested, with a pH of 4.5 or higher suggesting BV.
Another diagnostic tool is the “whiff test,” where a sample of discharge is mixed with a solution to check for a fish-like odor. Once diagnosed, BV is treated with antibiotic medications. These antibiotics, such as metronidazole or clindamycin, are available in various forms, including oral pills, vaginal gels, or creams.
It is important to complete the full course of prescribed medication, even if symptoms improve earlier, to ensure effective treatment and help reduce the likelihood of recurrence. BV is known to recur, with about half of treated cases returning within 6 to 12 months.
Supporting Vaginal Health During Perimenopause
Maintaining vaginal health during perimenopause involves several practices that can help support the vaginal microbiome and address discomfort. Avoiding certain products can contribute to a healthier environment. This includes refraining from douching, which can disrupt the natural balance of vaginal bacteria, and avoiding harsh soaps, perfumes, and scented feminine products that can cause irritation.
Wearing breathable underwear, such as cotton, can also support vaginal health by preventing moisture buildup. Practicing good hygiene, like wiping from front to back, helps prevent bacteria from the anal area from entering the vagina. Staying well-hydrated is also beneficial for maintaining natural lubrication.
Vaginal moisturizers and lubricants can provide comfort for dryness, which is a common perimenopausal symptom. These over-the-counter products can alleviate irritation and pain, including during sexual activity. For more persistent symptoms, localized estrogen therapy may be considered.
Localized estrogen, available as creams, vaginal rings, or tablets, delivers a small amount of estrogen directly to the vaginal tissues. This can help restore vaginal tissue health, elasticity, and acidity, promoting the growth of beneficial Lactobacillus bacteria and reducing the risk of infections. Probiotics (oral or vaginal) containing specific Lactobacillus strains may also support vaginal health. Consulting a healthcare provider is important to determine the most suitable approach.