Treatment for vaginal dryness, painful sex, frequent UTIs, and urgency.
A healthy vaginal pH is 3.5 to 4.5, but as you progress through menopause and well beyond, your vaginal pH can become elevated. You may also notice changes and discomfort in the vulva, vaginal environment, urinary tract, and bladder. The medical term for this is vaginal atrophy, or the genitourinary syndrome of menopause.
If your vaginal pH is off, you may find yourself trying to treat what seems like a yeast infection, bacterial vaginosis, or UTI symptoms. Medications like antibiotics or antifungals could be appropriate for your symptoms, but they may not address the underlying problem. So what can you do to balance your vaginal pH?
Menopause triggers more than hot flashes and night sweats. When it comes to menopause symptoms, there are whole-body menopause symptoms, and there are vaginal menopause symptoms.
Interestingly, vaginal menopause symptoms are chronic and progressive. This means that common concerns like vaginal dryness, itching, burning, painful sex, frequent UTIs, and urgency won’t magically get better with time. Instead, they’ll probably get worse.
Menopause is defined as the absence of your periods for one year. However, symptoms can start in perimenopause - a period of fluctuating hormones that can last for years before the stop of your periods. In either case, declining estrogen levels can lead to uncomfortable vaginal symptoms, including an elevated vaginal pH.
Hormonal shifts throughout a woman’s life will affect the vaginal microbiome (2). So it’s key to understand how the vaginal microbiome changes as you move through the dramatic hormonal shifts of menopause.
Vaginal pH depends on the presence of protective bacteria in the vaginal bacterial community (or vaginal microbiome). In a healthy vaginal microbiome, Lactobacillus is the dominant protective bacteria.
After menopause, the vaginal microbiome changes because of decreased estrogen. Women are less likely to have a protective vaginal bacterial community and less likely to have a healthy vaginal pH (3, 4).
Interestingly, the vaginal microbiome of a postmenopausal woman has many similarities with the microbiome of a reproductive-aged woman with BV or bacterial vaginosis (5). There’s a higher vaginal pH and a higher diversity of bacteria. Symptoms can include:
However, for postmenopausal women, abnormalities in the vaginal microbiome reflect a decline in protective bacteria rather than an increase in harmful bacteria (6, 7).
So what does this mean for your vaginal health? Well, if you’re treating your symptoms with antibiotics (as if you have bacteria vaginosis or a UTI) then you may be eliminating what little protective bacteria you have. This might lead to repeat infections.
For vaginal menopause symptoms, vaginal estrogen can be a safe and effective treatment option.
According to the research, treatment with vaginal estrogen is associated with an increase in protective bacteria (8, 9). This suggests that the best treatment for vaginal menopause symptoms is vaginal estrogen, rather than antibiotics (5).
There is no treatment that can restore vaginal pH overnight. But with consistent use, vaginal estrogen will work to improve the condition of the overall vaginal environment and restore vaginal pH to healthy levels. You may notice results within a couple of weeks, with continued improvements over the subsequent weeks and months.
Remember, vaginal menopause symptoms get worse with time and without treatment. Vaginal estrogen can help reverse symptoms, improving your overall health and quality of life.
Besides vaginal estrogen, other prescription medications have been shown to help balance vaginal pH:
Certain lifestyle changes can also be helpful:
Whether you’re 40 years old or 90 years old, declining estrogen levels can throw off your vaginal pH. If you’re experiencing vaginal infections or discomfort, remember, the usual antibiotics or antifungals may not address the root cause.
Take a step back and determine if you are in perimenopause or menopause. And remember, genitourinary symptoms such as elevated vaginal pH, vaginal discomfort, or vaginal infections are not only common - they’re highly treatable and preventable with vaginal estrogen.
At Interlude, our medical team is here to support you on your journey to optimal vaginal health through menopause and beyond. Take our quiz, explore our treatment options, and learn how this all works.
Interlude offers online treatment and support for menopause-related symptoms. Women can access a provider that acknowledges the importance and safety of prescription treatment, feel comfortable talking about private topics, and get ongoing treatment delivered.
Kelly Casperson, MD is a board-certified physician, urologist, international podcaster, and best-selling author. Listen to her podcast on Spotify, Apple Podcasts, and Google Podcasts. Her book You Are Not Broken: Stop "Shoulding" All Over Your Sex Life" is available on Amazon.