The Roles of the Vaginal and Urinary Microbiomes in Women’s Health

Written By Wendy Hansen

The vaginal and urinary microbiomes play crucial and interconnected roles in women's health, particularly as we age and experience hormonal changes. These delicate ecosystems don't operate in isolation but rather function as part of an integrated system that responds to hormonal fluctuations, particularly estrogen.

Estrogen plays a role in vaginal health by stimulating surface lining cells to produce glycogen, a carbohydrate that serves as the primary food source for Lactobacillus bacteria. These beneficial bacteria—primarily Lactobacillus crispatus, along with other species—metabolize glycogen into lactic acid, creating the acidic environment (pH below 4.5) that protects against pathogens. This acidic barrier isn't just a local defense; it helps maintain the integrity of the entire urogenital system.

During perimenopause and menopause, the decline in estrogen levels disrupts this system. As estrogen decreases, glycogen production diminishes, providing less "food" for Lactobacillus species. This leads to a reduction in lactic acid production and consequently raises the vaginal pH to more alkaline levels—often above 5.0. This pH shift creates an environment where protective Lactobacillus species struggle to maintain dominance, while potentially harmful bacteria can flourish.

The urinary microbiome, closely connected to the vaginal environment, experiences similar changes. The urethra's proximity to the vagina means that alterations in the vaginal microbiome frequently influence urinary bacterial populations. Additionally, estrogen receptors in the bladder, urethra, and pelvic floor muscles respond directly to declining hormone levels, affecting tissue quality and function. The resulting thinning of urethral tissue, decreased muscle tone, and altered bacterial composition creates conditions that can lead to increased urinary symptoms during menopause.

Impact on Health and Common Conditions

The hormonal and microbial changes during menopause often lead to a range of health challenges. Many women experience recurrent urinary tract infections that become increasingly resistant to treatment. The changes in urethral tissue and bladder function may result in overactive bladder symptoms, including frequency, urgency, and incontinence that significantly impact quality of life.

In the vaginal environment, the shift in pH and bacterial populations frequently leads to conditions like bacterial vaginosis, characterized by an overgrowth of diverse anaerobic bacteria that replace the protective Lactobacillus species. Vaginal dryness becomes common as tissue elasticity and lubrication decrease, which is not only uncomfortable, but can have serious consequences. The risk of various reproductive tract infections increases substantially as the protective mechanisms of a healthy microbiome diminish.

Nutritional Approaches for Microbiome Health

  • Increase fiber

  • Eat foods rich in flavonoids (cranberries, blueberries, other colorful fruits)

  • Make sure you are getting enough calcium, vitamin D, and folate

  • Try fermented foods

  • Reduce sugar intake

  • Reduce intake of high fat foods

  • Reduce or eliminate ultra processed foods

Lifestyle Approaches for Microbiome Health

  • Stay hydrated

  • Maintain appropriate hygiene without over-cleaning

  • Choose cotton underwear

  • Consider menstrual cups over tampons

  • Avoid douching

  • Use healthy lubricants - Lubricants containing glycerin and coconut oil can be disruptive to the microbiome. Oleic acid and olive oil may be beneficial.

  • Practice stress management techniques to reduce cortisol

  • Avoid tobacco exposure

  • When using antibiotics, consult your doctor regarding steps to mitigate their impact on the microbiomes

  • Participate in regular exercise

  • Prioritize sleep

The vaginal and urinary microbiomes play crucial roles in women's health. By understanding how diet, lifestyle choices, and medical interventions affect these delicate systems, women can take proactive steps to maintain their microbiome health. Whether you're experiencing hormonal shifts, managing recurrent infections, or simply focusing on preventative care, supporting these microbiomes through evidence-based approaches can significantly improve comfort, function, and overall wellbeing. If you need more guidance, schedule a free exploratory call with me and let’s talk. I can help.

Sources:

  1. Photo by CDC on Unsplash

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Wendy Hansen
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