- Menopause can cause changes in the vaginal microbiome, leading to shifts in vaginal odor and other symptoms.
- Lower estrogen levels during menopause reduce Lactobacillus and increase bacterial diversity, which may cause vaginal odor.
- Hormone replacement therapy (HRT) may help maintain a healthy vaginal microbiome and potentially reduce odor.
- Lifestyle changes, such as a healthy diet and avoiding harsh products, can support vaginal health during menopause.
- Probiotics containing Lactobacillus strains can support the vaginal microbiome and may help manage menopausal symptoms.
Embrace Change: Managing Vaginal Odor During Menopause
Summary
Menopause is the natural time of life when a woman’s menstrual periods stop for good. In the United States, 51 is the average age of menopause. But it can happen any time around your 40s or 50s, bringing changes that can feel unfamiliar and challenging.
Among these changes, you may notice a shift in vaginal odor during menopause. While this is normal, many women want to do something about it. Understanding vaginal changes during menopause can empower you to manage your symptoms effectively. Let's dive into why this happens and how you can take control of it.
The vaginal microbiome and menopause
Starting at puberty, your body ramps up the production of estrogen and glycogen. These both increase the thickness of the vaginal walls and maintain a protective mucus layer, which promotes the growth of protective Lactobacillus [1]. These bacteria are your vagina’s best friends, keeping the environment balanced and healthy.
As you approach menopause, your estrogen and glycogen levels drop. This change affects the thickness of the vaginal walls and the amount of protective mucus, leading to a decrease in Lactobacillus. Specifically, studies have shown that compared to premenopausal women, postmenopausal women have fewer types of Lactobacillus species [2] and are less colonized with L. crispatus [3]. Other studies have found that a Community State Type (CST) 4 is more common after menopause, that is, low levels of Lactobacillus and high diversity of disruptive bacteria [4], [5].
While all of these vaginal changes during menopause are common, they have been associated with having more severe menopausal symptoms, like vaginal dryness, soreness, and pain during sex [4], [6].
Vaginal odor during menopause
It’s normal for your vagina to have a slight odor. So why do 24-55% of postmenopausal women complain about vaginal odor during menopause [7], [8]? Let’s explore how vaginal changes during menopause may hold the answer.
Vaginal odor change is part of genitourinary syndrome of menopause (GSM). This condition includes various symptoms triggered by lower estrogen and other sex hormones during menopause. Symptoms of GSM include vaginal dryness, irritation, recurrent urinary tract infections, and vaginal odor [9].
Vaginal odor is primarily caused by the activity of vaginal microbes. Any changes in the vaginal microbiome, such as a shift in the types or amounts of bacteria present, can affect how the vagina smells.
A 'fishy’ vaginal odor comes from microbial products known as biogenic amines (BAs). Research has identified several bacteria that can produce BAs, including Escherichia coli, Veillonella, Prevotella, and Megasphaera [10]. Women with a CST 4 tend to have more BA-producing bacteria and higher BA levels [10], [11]. Postmenopausal women often have CST 4 [4], [5], so this explains the changes in vaginal odor during menopause.
It’s important to note, infections like bacterial vaginosis (BV) can also lead to noticeable changes in vaginal odor. But infections are accompanied by other symptoms like itching, unusual discharge, and burning.
Can hormone replacement therapy help with vaginal odor?
Hormone replacement therapy (HRT) can help alleviate some symptoms of menopause by replacing the estrogen and/or progesterone your body is no longer producing. This can support the vaginal microbiome and help maintain a healthy pH level, potentially reducing unpleasant odor.
HRT can be administered in different ways. Systemic treatment that is absorbed into the body may include oral pills, skin cream, patches or gel, or rings. Lower dose estrogen may also be applied directly to the vagina in a cream, tablet, or ring. Vaginal HRT may help vaginal and urinary symptoms without the side effects of systemic treatment [12].
Although there are no studies looking directly at HRT and its effects on vaginal odor during menopause, studies have shown that it can support your vaginal microbiome by:
- Increasing the levels of Lactobacillus
- Reducing bacterial diversity
- Lowering the vaginal pH
- Reducing the levels of bacteria associated with BV, like Prevotella and Gardnerella
- Reducing the levels of some BAs [5], [13]–[15].
These changes suggest that HRT could likely help with vaginal odor as well. If you want to give it a try, talk to your healthcare provider to find the best treatment option for you.
It’s important to understand both the benefits and potential downsides of hormonal treatment. For instance, HRT may increase the risk of breast cancer, as oral HRT raises estrogen levels in your blood. High estrogen has been linked to a higher risk of breast cancer. However, this risk varies for each woman, so it’s essential to discuss this option with your healthcare provider [16], [17].
Another alternative is ospemifene, a non-hormonal drug approved by the FDA in 2013. Ospemifene supports the vaginal lining and helps relieve vaginal dryness and pain during sex [18]. While we don’t know if ospemifene helps with vaginal odor, one study shows it can increase Lactobacillus levels, which may reduce odor [19]. It's important to note that since ospemifene has only been in use since 2013, there are no studies yet on its long-term effects.
How to manage vaginal odor during menopause
Here are some science-backed tips to support your vaginal microbiome and potentially reduce vaginal odor.
Ditch unhealthy fats and processed foods
There aren’t studies yet on how diet affects vaginal odor. But some studies connect a diet high in saturated fats, processed food, and refined grains with higher risk of BV and more menopause symptoms [20]–[22]. On the other hand, studies associate a diet low in fat and rich in high-fiber foods with lower risk of BV and fewer menopausal symptoms [20], [23].
Take care of your vagina
Daily habits can significantly impact your vaginal health. Avoid douching, harsh soaps, and tight underwear. Instead, clean with just water and use loose cotton underwear to keep your vaginal microbes happy. Check out our blog post for more tips on supporting vaginal health.
Try Lactobacillus probiotics
While the impact of probiotics on vaginal odor hasn’t been studied, research shows that Lactobacillus probiotics can reduce other menopausal symptoms and improve the vaginal microbiome [24]–[27]. If you want to try them, know how to choose an effective vaginal probiotic formulation. Strains with positive results for menopausal symptoms include:
- L. acidophilus YT1
- L. crispatus LbV 88
- L. rhamnosus GR-1
- L. reuteri RC-14
Lactobacillus probiotics can also help HRT be more effective. When combined, probiotics allow the use of ultra-low doses of estrogen, which results in fewer side effects [28].
Take control of your vaginal health
Understanding how your body changes during menopause is the first step to managing uncomfortable symptoms. You have the power to support your vaginal health and address vaginal odor through a healthy diet, lifestyle choices, and medical options like HRT.
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References
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