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Vaginal odor

How to get rid of vaginal odor in perimenopause and menopause

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Vaginal odor is usually a sign of three things:

  • Changes to the balance of bacteria in the vagina
  • Urinary incontinence
  • A vaginal infection

If you’re in perimenopause or menopause, vaginal estrogen therapy is probably the best way to promote a healthy balance of bacteria. And if you’re experiencing vaginal dryness, pain with sex, frequent UTIs, and/or urinary incontinence, vaginal estrogen therapy will help with that too!

So how can vaginal estrogen therapy help you keep vaginal odor at bay? Our medical team is here to unpack the science vaginal estrogen therapy and how it can be beneficial to your vaginal health in perimenopause, menopause, and beyond.

Hormonal changes to the vaginal environment

During the reproductive years of a woman’s life, the vaginal environment is dominated by the beneficial bacteria Lactobacillus.(1,2) Lactobacillus thrive on the hormone estrogen and the presence of Lactobacilli in the vaginal environment has a protective effect on your vaginal health. This means that when Lactobacilli are present, there is a lower risk of problems like bacterial vaginosis and UTIs.(3-6)

Fast forward to perimenopause and menopause when the body is producing less estrogen, and the vaginal environment smells and feels very different. There is less protective bacteria and the vaginal pH is elevated.(2,7,8) We might try to complete a course of antibiotics, only to notice that the odor comes right back. We will probably also notice vaginal dryness, urinary incontinence, or frequent UTIs. This is called the genitourinary syndrome of menopause and it’s not an infection - but it’s more common than we realize. It’s a consequence of declining hormone levels and it tends to get worse with time and without treatment.

Interestingly, the vaginal environment of a post-menopausal woman looks very similar to the vaginal environment of a pre-menopausal women with bacterial vaginosis (BV) - with a higher diversity of bacteria and an elevated vaginal pH.(7, 9) However, if you are in perimenopause or menopause and have recurrent BV symptoms, it may not be the usual suspects (e.g. new sexual partner, not using condoms, or douching) that are causing the unwanted vaginal odor. It’s probably lack of estrogen.

But don’t despair. In most cases, vaginal estrogen therapy can help increase the levels of protective bacteria and restore vaginal pH to healthy levels. With consistent use, vaginal estrogen will probably eliminate vaginal odor and prevent symptoms from recurring.

Types of vaginal odor

The vagina is self-cleaning, so it is normal for the vagina to produce different scents and odors as discharge comes out of the vagina. Internal washing, cleansing, or douching is never recommended. However, some odors are not normal and can indicate a problem that needs attention.

Fishy vaginal odor

Fishy vaginal odor and an elevated pH tend to mean that harmful bacteria dominate the vaginal environment. This is usually diagnosed as bacterial vaginosis and a medical professional can easily treat it with antibiotics.

As we mentioned before, it’s common for women to notice changes to the vaginal microbiome around the time of menopause. If lack of estrogen is causing your vaginal symptoms, then you’re probably seeing a decrease in healthy bacteria rather than an increase in harmful bacteria.(10,11) If this is the case, then antibiotics can address the harmful bacteria, but this will not address the underlying lack of protective bacteria. The good news is that treatments like vaginal estrogen cream are associated with an increase in protective bacteria.(12,13) This suggests that for women in perimenopause or menopause, vaginal estrogen therapy is the best way to promote a healthy vaginal environment, rather than antibiotics.(14)

Ammonia or urine-like vaginal odor

Vaginal odor that smells like bleach or ammonia usually indicates urine leakage. Urinary incontinence is common around the time of menopause, and it’s a telltale sign of the genitourinary syndrome of menopause. Incontinence is not a serious condition, but it can really impact your quality of life.

Although urinary incontinence is highly preventable, many women will wait years to get help from a medical professional and will instead rely on liners and pads. While panty liners and pads can help absorb urine leakage, it may never feel quite as fresh and clean as before. In many cases, vaginal estrogen can help decrease urinary incontinence and decrease the need for liners and pads - helping you feel fresh and in control.

How to treat vaginal odor

Whether it’s hormonal changes, a new sexual partner, irritating products, or something else that’s causing vaginal odor - if you’re noticing vaginal discomfort, a doctor like a board-certified physician at Interlude can help diagnose the problem and suggest a course of treatment.

Antibiotics

If you’re dealing with an infection like bacterial vaginosis or trichomoniasis, then antibiotics can be a powerful way to get rid of your symptoms.

Vaginal estrogen

If you’re in perimenopause or menopause, then antibiotics alone are probably not sufficient. For many women experiencing vaginal changes around the time of menopause, vaginal estrogen is the best approach to promote a healthy vaginal microbiome.

If you need to clear an infection or promote a healthy vaginal microbiome, Interlude is here to help. Within hours, a board-certified doctor can assess your symptoms and if appropriate prescribe treatment for vaginal infections and menopause-related vaginal changes. Need more information? Take our quiz, browse our treatment options, and learn more about our easy and convenient telehealth consult. We are looking forward to taking care of you!

Disclaimer: This information isn't a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
References
1. Thoma ME, Gray RH, Kiwanuka N, et al. Longitudinal changes in vaginal microbiota composition assessed by gram stain among never sexually active pre- and postmenarcheal adolescents in Rakai, Uganda. J Pediatr Adolesc Gynecol 2011;24:42-47.
2. Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause 2014;21:450-458.
3. Ravel J, Gajer P, Abdo Z, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A 2011;108:4680-4687.
4. Lamont RF, Sobel JD, Akins RA. The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 2011;118:533-549.
5. Pybus V, Onderdonk AB. Microbial interactions in the vaginal ecosystem, with emphasis on the pathogenesis of bacterial vaginosis. Microbes Infect 1999;1:285-292.
6. Gupta K, Stapleton AE, Hooton TM, Roberts PL, Fennell CL, Stamm WE. Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization in women with recurrent urinary tract infections. J Infect Dis 1998;178:446-450.
7. Roy S, Caillouette JC, Roy T, Faden JS. Vaginal pH is similar to folliclestimulating hormone for menopause diagnosis. Am J Obstet Gynecol 2004;190:1272-1277.
8. Hillier SL, Lau RJ. Vaginal microflora in postmenopausal women who have not received estrogen replacement therapy. Clin Infect Dis 1997;25:S123-S126.
9. Brotman RM, Ravel J, Cone RA, Zenilman JM. Rapid fluctuation of the vaginal microbiota measured by Gram stain analysis. Sex Transm Infect 2010;86:297-302.
10. Cauci S, Driussi S, De Santo. et al. Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. J Clin Microbiol 2002;40:2147-2152.
11. Gliniewicz K, Schneider GM, Ridenhour BJ, et al. Comparison of the vaginal microbiomes of premenopausal and postmenopausal women. Front Microbiol 2019;10:193.
12. Galhardo CL, Soares JM, Simoes RS, Haidar MA, Rodrigues de Lima G, Baracat EC. Estrogen effects on the vaginal pH, flora and cytology in late postmenopause after a long period without hormone therapy. Clin Exp Obstet Gynecol 2006;33:85-89.
13. Heineman C, Reid G. Vaginal microbial diversity among postmenopausal women with and without hormone replacement therapy. Can J Microbiol 2005;51:777-781.
14. Menopause: The Journal of The North American Menopause Society Vol. 27, No. 9, pp. 976-992
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