Thrush and Vaginosis in Peri Menopausal and Post Menopausal Women

Vaginal and Gut Dysbiosis

Dysbiosis just means that the microbiome of bacteria in your gut/ vagina are imbalanced. Every single part of the human body lives in connection and symbiotically to microbiota. The vaginal and gut microbiome can both be (and often are) dominated by the species of Lactobacillus (L. crispatus, L. iners, L. gasseri and L. jensenii) in most women of menstruating age. Lactobacilli species produce lactic acid which helps maintain the pH of the vagina, around ~3.5-4.5, in addition to creating by-products which suppress the growth of negatively associated bacterial strains such as Neisseria gonorrheaI, (thrush causing) C. albicans or HIV.

There are naturally occurring opportunistic pathogens, who take advantage of weak microbiomes, and are normally kept in balance by the populations of beneficial bacteria. Certain common bacteria, L. crispatus, Prevotella bivia and Atopobium vaginae species appear to regulate the epithelial innate immune system, as gram negative bacteria (e.g. E. coli) in the presence of lactic acid has shown to stimulate an innate response. Therefore when these beneficial and regulatory bacteria are disturbed (e.g. antibiotic use) or overgrown (by other bacteria), such as state of bacterial dysbiosis (vaginosis or thrush), which increases the risk of infection, this may be mirrored by a state of dysbiosis in the gut.

How do hormones affect the microbiome? (hint: they work together)

It is suggested that dysbiosis in the genital tract or gut microbiome is associated with inflammatory conditions like endometriosis. Research shows an association between disturbed gut microbiota and inflammatory conditions, additionally leading to increased circulating oestrogen levels. A study comparing 14 control women with 14 endometriosis women found cervical, vaginal and gut microbiome composition was similar, but differed somewhat at genus level. Potentially pathogenic bacterium were increased in diagnosed endometriosis patients, including Shigella/ Escherichia in stool samples. This seems to be a differing response to ‘regular’ dysbiotic pathogenic disease processes however, and perhaps the rise in oestrogen is specific to endometrial cases and not in other (vaginal and gut) dysbiotic conditions. Regarding the change in oestrogen levels; Wilson, Lee, Balen and Rutherford (2007) suggest this change is responsible or influential on the increased risk for bacterial vaginosis, or at the very least, is immunomodulatory throughout the cycle. Vitali and colleges (2017) report during the luteal phase uterine cytotoxic T lymphocyte (CTL) activity and natural killer (NK) cell cytotoxic activity are suppressed whereas innate components are enhanced, which put the woman at an increased risk for infection - which would explain the increased overall risk for women with low oestrogen levels generally.

This is relevant to menopausal women as naturally they experience this drop off in oestrogen and are vulnerable to infection, there is a clear relationship between E2 (a hormone replacement) and colonisation with Lactobacillus. Which means that sufficient oestrogen is protective of the microbiome. Baker, Al-Nakkash & Herbst-Kralovetz (2017) reveal that oestrogens are regulated through the healthy gut microbiota via the secretion of beta-glucuronidase which deconjugate (transforms) oestrogens into their active form. Therefore, less biodiversity and less beta-glucuronidase secreting microbes equates to less active oestrogen.

This axis is bi-directional however, and hormonal regulation is able to modulate microbiota composition (i.e. microbial diversity and dominant strains). Treatments to restore natural and protective dominant species, as for bacterial vaginosis, include prebiotic fibres (i.e. fruits, vegetables, fibrous grains), probiotics (specifically the Lactobacillus crispatus, L. rhamnosus and L. reuteri) with the theory that they will overcrowd the pathogenic strains. Most off the shelf probiotics will contain Lactobacillus spp. strains - if it has only L. acidophilus and is in vegetable capsules - that's perfect.

Naturopathically speaking, this could be given orally as well as vaginally (as a pessary - google it) with little side effects. They may have faster effects if given this way, rather than orally.

You can also use coconut oil as a natural anti-fungal, but please seek help if nothing changes within a few days.

As always, consider talking to your health provider (whoever that is) or ask questions before commencing any self treatment.

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