Probiotics for Women | Probiotic use During Pregnancy & Menopause.
The human body contains trillions of microorganisms. Despite accounting for only 0.3% of our mass, they play a vital role in body function and human health. We're most familiar with their presence in the gut, and the majority of probiotic products are marketed for gastrointestinal issues. However, they reside in just about every area of the body, including the vagina. The vaginal microflora has been investigated for over 150 years and influences bacterial vaginosis, vaginal candidiasis and cystitis, to name a few.
So, what disrupts the vaginal microbiome?
The gut plays a role here, as bacteria can translocate from the gut to the vagina, so the usual factors of high sugar diet, high alcohol consumption, obesity, stress, and medications (oral contraception, hormone replacement therapy, steroids and antibiotics) stand. The vaginal pH is 3.5-4.5, maintained by lactic acid produced by the beneficial bacteria lactobacillus. Any change to this pH, particularly reducing the acidity, would create an environment where pathogenic bacteria may flourish. Exposure to synthetic chemicals, e.g. by using fragranced toiletries, can upset the vaginal pH, as can vaginal douching, exposure to semen and sexually transmitted diseases. The menstrual cycle and associated hormones also play a role. High levels of oestrogen can reduce the vaginal pH and menstrual blood and increase the pH. Therefore during menstruation, pregnancy and menopause, the risk of developing a bacterial infection is higher.
Probiotics can be a considerable support for women's health, whether that's the gut, bladder or vagina. Still, not all species of bacteria work in the same way, so it's essential to understand what will support you in each case.
Bacterial vaginosis (BV)
BV is the most common cause of vaginal discomfort in women and will affect one in three women in their lifetime. This stems from the introduction of pathogenic bacteria, predominantly Gardnerella vaginalis and Mycoplasma hominis, and a reduction in beneficial bacteria, thereby reducing the acidity and protection against infection. Signs of BV include unusual (thin and grey) discharge, fishy smell, vaginal itchiness, soreness and irritation. Typically, this is treated with multiple courses of antibiotics. However, without additional support, the vaginal microbiome can be further disrupted by this and result in recurring infections, which increases the risk of urinary tract infections, sexually transmitted diseases and complications in pregnancy.
Studies have shown that oral consumption of Lactobacillus rhamnosus, Lactobacillus reuteri and Lactobacillus acidophilus has been shown to survive transit through the gut and successfully translocate to and populate the vagina. The strains of Lactobacillus bacteria appear to be best for BV as they inhibit the growth of pathogenic bacteria and potentially help the immune system prevent further infection.
Vaginal candidiasis, better known as a yeast infection or thrush, affects 3 in 4 women at least once and 50% of women at least twice in their lifetime. Similarly to BV, it multiplies rapidly in moist warm conditions with a higher pH, and the symptoms include itching, a thick white discharge, pain during sexual intercourse, redness, burning, soreness and swelling.
Probiotics containing Lactobacillus acidophilus, Lactobacillus rhamnosus and bovine lactoferrin maintain Lactobacillus presence, stabilising pH, which can reduce the presence and symptoms of candidiasis.
As well as the vaginal microbiota, adult women also play host to the female urinary microbiota, which was only initially described in 2011, meaning much of the research and treatment of urinary tract infections has been conducted without consideration of this.
Lactobacillus is also the most dominating family of bacteria in the bladder and encourages a balanced microbiome.
Probiotics during Pregnancy
The benefits of probiotic supplementation supporting women aren't just with infections. Many significant scientific studies present the safety and benefits of probiotics during pregnancy and postpartum. It is important to note that some species, such as Saccharomyces boulardii, often used to reduce diarrhoea, have not undergone sufficient research into its safety and are not recommended during pregnancy. A midwife or medical professional should always approve any dietary changes when pregnant.
Pregnancy has a massive impact on the entire body, and the gut and vaginal microbiomes are not excluded from this. Changes to the gut microbiome become more pronounced as pregnancy progresses, with decreased diversity of bacteria and increased inflammation - which studies show may be linked to the onset of gestational diabetes mellitus. L. rhamnosus is particularly effective at reducing the occurrence of gestational diabetes in older women or those with a history of gestational diabetes. In addition, there are ongoing studies into the effectiveness of reducing allergies in a child and later in life. A key focus of this is eczema, as probiotics are often used for treating and preventing eczema in adults.
Studies on L. rhamnosus taken throughout pregnancy and postpartum also show beneficial effects on mental health, where subjects self-report lower anxiety and depression scores than those who did not supplement during pregnancy.
Everyone is unique, and it's always important to check with your healthcare provider when supplementing during pregnancy and confirm with the supplement provider that they are suitable.
Irritable bowel syndrome is far more common in women than in men, particularly the constipation-predominant subtype. The mechanism for why this is the case is currently unknown, and treatments have not been updated to account for this. Constipation is prevalent in women during menstruation and pregnancy; this can cause further problems as it prevents waste hormones from being excreted and can be reabsorbed into the bloodstream resulting in hormonal imbalances. The specific strain which has been shown to ease constipation is Bifidobacterium Lactis, particularly when accompanied by a prebiotic that helps support the growth of good bacteria in the gut. Once you have introduced the beneficial bacteria (probiotic), you must enable it to flourish by feeding it with soluble dietary fibre (prebiotic). Look for a probiotic product which contains FOS prebiotic.
In addition, bloating is far more prevalent in women than men and is often cyclical, worsening at certain points in the menstrual cycle due to the fluctuation of hormones. Whatever the trigger, the bloating process tends to be impaired digestion, causing excessive gas production, wind and bloating. Probiotics may support this; studies on Lactobacillus acidophilus have shown a reduction in bloating by 73%.
Preventing microflora disruption
Many factors influence our microbiome, some of which are in our control and may not be so obvious! Factors within our control are maintaining balanced blood sugars, keeping hydrated, supporting your gut with plenty of prebiotics and anti-inflammatory foods, wearing cotton underwear, avoiding vaginal douching and fragranced feminine hygiene products, regularly changing sanitary products and avoiding the use of bleach in the toilet (the fumes can rise).
However, we cannot control everything. Environmental toxins and excess stress are not always avoidable. Taking probiotics can be a tremendous support; there are topical probiotic ointments available for specific concerns which can provide faster relief; however, this is a reactive treatment rather than proactive. Why rely on repairing the issue rather than preventing its presence?
3. Human microbiome.