Estrogen, Vaginas & BV

Note: This post is not sponsored. Links to products are for information purposes only. Please consult your health care provider to help you decide what is the right course of action for *you*.

There is much to know about how estrogen supports genitourinary health. For this blog entry my focus is on one of my favourite topics – estrogen and the vaginal microbiome (also known as the vaginal flora).

During pre-menopause (your active reproductive years) estrogen causes the outer layer of vaginal cells to shed naturally. When they die off they release glycogen which converts to glucose (sugar). Lactobacillus (the “good” bacteria) coverts the glucose to lactic acid. This acid keeps pH levels in the healthy pre-menopause levels of 3.5 and 5.

When estrogen starts to diminish this vaginal cell shedding process slows down and the lactobacillus starves. The bacterial balance is disrupted and the “bad” bacteria takes over. The vaginal pH subsequently rises and can cause something called Bacterial Vaginosis (BV). This is the most common vaginal infection and is often symptomless of and when left untreated can raise the risk of Sexually Transmitted Infections (STIs). When there are symptoms they include thin, grey, white or green vaginal discharge, fishy vaginal odour, vaginal itching and burning during urination.

Recently, there have been new over-the-counter vaginal gels and suppositories on the market. They contain various acids with the aim of keeping the good bacteria fed. I wrote about some of them here. There is also the vaginal moisturizer Mae by Damiva * that contains topical sucrose. If you suffer from recurrent BV they may be something you’d like to consider.

Recommendations

If you think you have BV, I highly recommend you see your GP or gynaecologist to confirm this. There are a number of different vaginal infections as well as STIs that cause similar symptoms. Best to get an accurate diagnosis.

Keep in my mind vaginas don’t smell like flowers or spring fields. Dryer sheets do. Vaginas and vulvas have a slightly sweet or musky scent. BV can cause a very different scent – fishy.

Do not douche. This remedy is superficial, temporary and ultimately harmful. Treat the cause. Don’t camouflage the symptoms. Again, your vagina shouldn’t smell like Febreeze.

If you find you regularly have BV – for example, after your period or after being exposed to male ejaculate – you may want to consider post period or post sex use of the gels or suppositories.  Again, check with your doctor.

In my case, I have had BV so often over the years that even without major symptoms I just know when my vaginal microbiome balance is off. I got an IUD last July * and had spotting near daily for 6 months. BV seemed like my constant companion even though I tried to manage things with the gels and suppositories (as per my doctor’s recommendation). Once the spotting stopped I was treated with antibiotics. If it happens again, I will go that route again. Ultimately, I have the best, long lasting and more affordable results with antibiotics. It’s what brought me some relief and, pardon the expression, some a feeling of balance.

If you suffer with bacterial vaginosis I hope you find some relief too.

Resources

Centers For Disease Control & Prevention

 

* I will write more about it in a future post as it’s my current preferred day-to-day vaginal moisturizer. Also, I’m working on a post about why I chose to get an IUD when I did. Yes, it’s perimenopause related. Stay tuned!

 

That Smell Down There & How To Get Rid Of It

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.

My Situation

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.

Treatment

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’s available behind the counter at pharmacies, but isn’t 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, don’t 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.

Canesbalance Bacterial Vaginosis Gel supports healthy vaginal flora by restoring vaginal pH with a lactic acid formulation.

Relactagel contains lactic acid (which restores and maintains vaginal acidity favourable to the growth of lactobacilli) and 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!

Resources

BOOKS

The V Book: A Doctor’s Guide to Complete Vulvovaginal Health

Sex Rx: Hormones, Health, and Your Best Sex Ever

YOUTUBE

Bacterial Vaginosis and Diet

Treating Bacterial Vaginosis with Vaginal Vitamin C

PS

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.