Bacterial Vaginosis & Perimenopause
Bacterial Vaginosis (BV) can occur when the vaginal environment experiences a change in flora equilibrium – when healthy lactobacilli is diminished which then creates extra production of less desirable bacteria. This harmful bacteria produces enzymes that break down vaginal protein and causes an unpleasant discharge and odour. What researchers and doctors are discovering is that this change is often due to an increase in pH (normal levels are 3.5-5 on a scale of 0 to 14 – so low and acidic).
An increase in pH can be caused by: menstruation (blood has a pH of 7.4), semen (ph of 7.1-8), perimenopause and menopause (because when estrogen declines vaginal pH rises), douching, medications (allergy and cold medications can dry out tissues and sometimes affect vaginal pH), and antibiotics (they are meant to kill the harmful bacteria but also end up killing off beneficial bacteria).
Not treating BV can increase the risk of contracting HIV and other sexually transmitted infections (if exposed), increase the risk of premature delivery if you’re pregnant, and the development of pelvic inflammatory disease (PID). Serious stuff! So besides the symptoms being rather unpleasant, it’s a dangerous condition for your genitourinary well-being.
Symptoms of BV: unusual vaginal discharge (white, milky or gray – also foamy or watery), strong fish-like odour (especially after sex or exercise), burning when urinating, itching around the outside of the vagina, and vaginal irritation.
There still isn’t a lot known about BV even though it’s the most common vaginal infection. When you do a Google search though you end up with a TONNE of results (hey, it’s how you likely found this post), but most are upsells for booklets of at-home treatments that have not been tested for efficacy or safety. I think if you think you have BV, it’s better to consult your doctor, get a proper diagnosis and appropriate treatment.
If you test positive for BV the likely treatment will be a prescription medication called metronidazole (oral tablets or vaginal gel). It does work, but even so most people will have a reoccurrence within 3-12 months. Finding ways to keep the vagina happily balanced pH wise after the prescription can help keep BV at bay. It requires being quite diligent about your flora. And yes, I’m speaking from experience.
The last few years I’ve dealt with recurrent bouts of BV – especially after my period. Basically, I’m getting a double punch of high pH. From my period and from my estrogen levels because of perimenopause. I also take allergy and sinus medication and I’m generally quite dry EVERYWHERE I have mucous membranes so I think my pH might be affected by this as well. What I don’t do is have unprotected sex and I never douche. At least I have that going for me.
I went to my local sexual health clinic (Clinique A in Montreal and later The Sexual Health Centre in Ottawa) as part of my regular STI testing routine and brought up my symptoms. I knew something was fishy (bahahaha) and I was right.
I’ve been prescribed metronidazole for BV a few times. It’s harsh on your stomach, but I don’t drink alcohol and I’m good with taking medication on a full stomach so I didn’t have any side effects. The BV cleared up fast and I was fine for two or three months, but then it came back. My health care practitioner then suggested a specially formulated Vitamin C tablet called Prevegyne that is inserted vaginally. It helps create and maintain a more acidic state. It is available behind the counter at pharmacies, but is not covered by most insurance plans (in Quebec and Ontario – I cannot speak to other areas). It isn’t a one time treatment. It’s something to take to treat as well as regularly to prevent.
By the way, do not take regular vitamin C tablets. They are not the right dose and they are not capsuled the same way. It will burn!
In the name of science I have also tried other over the counter BV treatments that aim to treat and prevent. Like the Prevegyne they will most likely have to be used once a month for a few days (usually after your period) to keep the bacteria at a healthy, pleasant equilibrium. Your health practitioner can help you figure out how much and how often to take them.
Relactagel which contains lactic acid that restores and maintains vaginal acidity favourable to the growth of lactobacilli as well as glycogen which provides nutrients for lactic acid producing bacteria.
Probaclac is a multi-strain probiotic complex that is inserted into the vagina nightly for 14 days to help build up the lactobacilli and prevent overgrowth of the harmful bacteria.
RepHresh Gel contains policarbophil which is a bioadhesive ingredient that can maintain a healthy physiological vaginal pH.
RepHresh Pro Biotic is an oral capsule that contain patented and clinically tested strains of probiotic lactobacillus that have been shown to balance yeast and bacteria.
I will write about my experiences with each treatment in future blog posts. For now, do know that I think they all showed some benefit. I think by addressing vaginal pH we have finally turned the corner when it comes to managing this condition (not eliminating it, but managing it).
I wish the science brains had figured it out sooner!
BV is condition that can affect those of us with vaginas whether we are CIS, trans or gender nonbinary. I’m trying to write in a way that reflects this, but I may mistakes from time to time. Thanks for your patience and understanding.