Vaginal microbiome and hormonal changes during menopause
- Norman Reffke
- 4 days ago
- 22 min read
Imagine standing in the shower in the morning and suddenly noticing an unusual odor or a change in your vaginal discharge – even though you feel perfectly healthy and maintain your hygiene as meticulously as ever. What many women experience from their mid-40s onward is not a cause for panic, but rather a fascinating biochemical shift that offers a glimpse into the secrets of our female bodies. Menopause brings not only hot flashes and mood swings – it also revolutionizes the delicate ecosystem of your vaginal flora in a way that even scientists have only begun to fully understand in recent years.
This comprehensive article explains why your vaginal microbiome changes so dramatically during perimenopause and menopause, which hormones play the key roles, and how targeted measures can not only support your intimate health but also improve your overall well-being. Because one thing is certain: knowledge is the first step towards greater self-determination and health during this exciting phase of life.
The hormonal revolution of menopause
Menopause is far more than just the end of fertility—it's one of the most profound hormonal shifts your body will ever undergo. To understand why your vaginal microbiome changes so drastically during this time, we first need to look at the complex hormonal dominoes that fall during this phase of life.
Five to ten years before your last menstrual period, during the so-called perimenopause, your body begins to alter its hormonal balance. The ovaries produce increasingly irregular amounts of estrogen and progesterone – sometimes too much, sometimes too little, often completely unpredictably. These fluctuations are not only responsible for hot flashes and sleep disturbances, but also affect every inch of your mucous membranes.
Imagine your hormones like a well-rehearsed orchestra: For decades, estrogen, progesterone, testosterone, and other messenger substances have played together harmoniously, also regulating the health of your vaginal lining. Now, during menopause, each musician gradually leaves the orchestra – initially in a chaotic and uncoordinated manner.
Scientific fact: Estrogen levels can fluctuate by up to 90% during perimenopause – sometimes within just a few weeks. These extreme fluctuations explain why many women report that their body image changes almost daily.
What makes these hormonal changes so significant for your vaginal microbiome? Estrogen isn't just a sex hormone – it's a master regulator of your mucous membrane health. It controls blood flow, moisture production, tissue elasticity, and – most importantly – the pH level of your vagina.
Progesterone, often called the "relaxation hormone," also plays a crucial role. It modulates your immune system and influences how your body responds to the natural bacteria in your vagina. When progesterone levels drop, your immune response can change—sometimes becoming overactive, sometimes too weak.
🧠 Reflection question: Have you noticed any changes in your body awareness, energy levels, or discharge in recent months? Write down these observations in a small journal – they can provide important clues about your hormonal changes.
The vaginal microbiome – an underestimated ecosystem
Your vagina is home to a fascinating universe of millions of microorganisms – an ecosystem that is more complex and important than most people realize. This vaginal microbiome isn't simply "there," but actively works to protect and maintain your health.
In a healthy, premenopausal vagina, lactobacilli usually dominate – friendly bacteria that produce lactic acid, maintaining an acidic environment with a pH between 3.8 and 4.5. This acid acts like a natural shield against harmful bacteria, fungi, and viruses. Imagine your lactobacilli as the guardians of a medieval fortress – continuously producing "acidic arrows" to keep intruders out.
But here's where it gets interesting: These lactobacilli are by no means independent of your hormones. They need glycogen – a type of sugar that your vaginal cells produce under the influence of estrogen – as food. Less estrogen means less glycogen, less food for the lactobacilli, and therefore an imbalance.
Scientific studies have shown that the vaginal microbiome doesn't just have a local effect. It's in constant communication with your immune system, influencing inflammatory processes throughout the body and can even affect your mood and mental health – via the so-called vagina-brain axis, a field of research that has only received intensive attention in recent years.
The diversity of your vaginal microbiome is as unique as your fingerprint. Researchers have discovered that there are five main types of vaginal microbiome, known as "Community State Types" (CST). Every woman has her own microbial "fingerprint," shaped by genetics, lifestyle, partners, and—particularly relevant to our topic—hormonal changes.
✅ Micro-exercise: Keep a "microbiome diary" for one week: Note your energy levels, mood, digestion, and any changes in your intimate area daily. You'll be surprised how many connections you discover!
Estrogen – the conductor of your intimate health
Estrogen is far more than just a "female hormone"—it's the primary architect of your vaginal health. To understand why the declining estrogen levels during menopause have such a dramatic impact on your vaginal microbiome, we need to take a closer look at the many roles this hormone plays.
Imagine estrogen as the head chef in a restaurant: it not only ensures that all the ingredients (in this case, the nutrients for your vaginal cells) are present in the right amounts, but also orchestrates the entire cooking process. Estrogen stimulates the vaginal cells to produce glycogen – the "favorite nutrient" of the protective lactobacilli.
But estrogen does much more: It maintains the elasticity and thickness of the vaginal wall, promotes blood flow and thus the oxygen supply to the tissue, and regulates lubrication. When estrogen levels drop, the vaginal wall becomes thinner (atrophy), less vascularized, and drier – a process that doctors call "vulvovaginal atrophy."
These changes have a direct impact on your microbiome: Less glycogen means less food for the "good" bacteria. At the same time, the pH level changes – instead of the healthy 3.8-4.5, it can rise to 5.5 or higher. In this less acidic environment, opportunistic bacteria and fungi can multiply more easily.
Fascinating research: A study published in 2023 in the journal "Menopause" showed that women receiving hormone replacement therapy had a significantly more stable vaginal microbiome than women not receiving hormone therapy. The diversity of lactobacilli was up to 60% higher.
Of particular interest is the discovery that estrogen also modulates local immune functions. It influences the production of antibodies (especially immunoglobulin A) in the vaginal mucosa and regulates inflammatory processes. When estrogen is lacking, the immune system can overreact and promote chronic, low-grade inflammation—a condition that favors the growth of harmful microorganisms.
Another fascinating aspect: Estrogen also influences gene expression in vaginal cells. Under the influence of estrogen, these cells produce not only glycogen but also antimicrobial peptides – natural antibiotics that fight harmful germs. Without sufficient estrogen, this natural defense is lost.
The good news: Your body is remarkably adaptable. During the transition period, targeted measures can help mitigate the effects of estrogen deficiency and stabilize your vaginal microbiome.
🌱 Awareness exercise: Take five minutes and consciously tune into your body. How does your intimate area feel? Is there any dryness, tightness, or changes? This mindfulness is the first step towards loving self-care.
The interplay of other hormonal factors
While estrogen undoubtedly plays the main role in regulating the vaginal microbiome, it is by no means the only player on this hormonal stage. Progesterone, testosterone, cortisol, and even thyroid hormones interact in a complex network that influences the health of your vaginal flora.
Progesterone, often described as the "antagonist" of estrogen, actually plays a much more nuanced role. It acts as a natural immunomodulator and can have both anti-inflammatory and pro-inflammatory effects – depending on the context and concentration. During a normal menstrual cycle, progesterone ensures that the immune system is somewhat downregulated in the second half of the cycle to avoid jeopardizing a potential pregnancy.
During menopause, progesterone levels often drop even more dramatically than estrogen levels – sometimes by up to 95%. This progesterone deficiency can lead to chronic overactivation of the immune system, which can manifest as recurring vaginal discomfort, increased susceptibility to infections, and an imbalanced microbiome.
Testosterone – yes, you as a woman also produce this hormone – plays an important role in the health of your mucous membranes. It supports collagen production, promotes blood flow, and can increase the resilience of vaginal tissue. The age-related decline in testosterone production contributes to tissue thinning and increased vulnerability.
Surprising finding: Women with higher testosterone levels in postmenopause often show better vaginal health and fewer problems with dryness or recurring infections.
Cortisol, your stress hormone, deserves special attention. Chronic stress and the resulting elevated cortisol levels can significantly disrupt the vaginal microbiome. Cortisol suppresses the local immune response, reduces the production of protective immunoglobulins, and can inhibit the growth of lactobacilli. At the same time, it promotes the growth of Candida fungi – one reason why women under stress are more prone to yeast infections.
The thyroid hormones T3 and T4 influence the metabolism of all body cells, including vaginal cells. Hypothyroidism, which is more common during menopause, can impair the regenerative capacity of the mucous membranes and increase susceptibility to dysbiosis.
Insulin and other metabolic hormones also play a role. High blood sugar levels can promote fungal growth and disrupt the pH balance. This explains why women with diabetes or insulin resistance are more likely to experience vaginal problems.
🔍 Self-reflection: What stressors are currently affecting you? Make a list and consider which ones you can influence. Stress management is an important component of your hormonal balance and therefore also of your intimate health.
Immune system and mucous membrane health in balance
Your immune system and the health of your vaginal lining are in constant, finely tuned interplay. This relationship becomes particularly complex during menopause, as both hormonal signals and the immune response undergo fundamental changes.
The vaginal mucosa is not just a passive barrier – it is an active immune organ. Specialized immune cells, called dendritic cells, continuously patrol the tissue and distinguish between "friend" and "foe." Under the influence of estrogen, this system usually functions smoothly: beneficial lactobacilli are tolerated, while potential pathogens are recognized and fought off.
As estrogen levels decline, this finely balanced equilibrium shifts. The local immune system can become hypersensitive and begin to perceive even harmless bacteria as a threat. This can lead to chronic, low-grade inflammation – a condition researchers refer to as "inflammaging" (inflammation + aging).
At the same time, the physical barrier function of the mucous membrane weakens. The vaginal wall becomes thinner, the cell junctions (tight junctions) loosen, and the production of antimicrobial peptides decreases. Imagine the city wall becoming lower and more fragile, while at the same time the guards become less vigilant – a perfect storm for invading pathogens.
Scientific breakthrough: Recent research shows that the vaginal microbiome actively "communicates" with the immune system. Certain strains of lactobacilli produce molecules that can directly influence immune cells and reduce inflammation.
The vaginal immune system is closely linked to the systemic immune system. Chronic inflammation in the genital area can increase inflammatory markers throughout the body and contribute to the development of autoimmune diseases, cardiovascular problems, and even depression. Conversely, systemic inflammation can negatively impact vaginal health.
Particularly fascinating is the discovery of so-called "mucosal immunity"—a specialized immune system that connects all the body's mucous membranes. A disruption of the vaginal mucosa can affect the intestinal mucosa, the oral mucosa, and even the nasal mucosa. This explains why some women in menopause develop not only vaginal problems but also more frequent colds, digestive issues, or gum problems.
The good news: You can specifically strengthen your mucosal immune system. Certain nutrients, probiotics, and lifestyle factors can help restore balance and optimize your natural defenses.
💪 Immune boost for today: Drink a glass of water with a teaspoon of high-quality apple cider vinegar (with the "mother"). The probiotic bacteria and organic acids can support your mucosal immune system. Start with small amounts and listen to your body.
Understanding and classifying changes in discharge
Vaginal discharge is like a window into the health of your microbiome – it reveals more about your intimate health than you might think. During menopause, the consistency, amount, odor, and pH of discharge often change dramatically, and these changes can initially be alarming.
Normal, healthy vaginal discharge is a masterpiece of nature: It consists of dead cells from the vaginal wall, secretions from the Bartholin's glands, cervical mucus, and the metabolic products of your microbiome bacteria. Under the influence of estrogen, this discharge is usually clear to milky white, odorless or slightly sweet, and has a pH value between 3.8 and 4.5.
With the hormonal changes of menopause, this picture changes: Vaginal discharge often becomes lighter because less glycogen, and therefore fewer nutrients, are available for the acid-producing lactobacilli. At the same time, the pH level can rise – sometimes to 6.0 or higher. In this more alkaline environment, other types of bacteria can colonize, producing a characteristic "fishy" odor.
Many women report experiencing the following changes during menopause:
Dryness: Less discharge overall, feeling of tightness or "sandpaper"
Odor changes: From neutral to metallic, fishy, or sweetish
Changes in consistency: From smooth and slippery to sticky or crumbly
Color changes: Yellowish or grayish discharge without infection
pH increase: Measurable with pH test strips from the pharmacy
Important distinction: Not every change in vaginal discharge during menopause indicates an infection! Often, these are normal adjustments to hormonal changes. However, you should consult a gynecologist if you experience persistent discomfort, itching, burning, or an unusually strong odor.
Atrophic vaginitis, an inflammation of the vaginal lining due to estrogen deficiency, is particularly common during menopause. It often manifests as increased, yellowish-white discharge, which may be accompanied by burning or itching. Unlike infections, this inflammation is sterile – meaning it is not caused by pathogens but by the hormonally induced thinning of the vaginal tissue.
Another common phenomenon is bacterial vaginosis – an imbalance of the vaginal flora in which the protective lactobacilli are overgrown by other bacteria. This leads to a characteristic fishy odor, especially after intercourse, and a thin, grayish discharge. Bacterial vaginosis is more common during menopause because the altered hormonal environment disrupts the balance of microbiome bacteria.
Fungal infections can also increase during menopause, but for different reasons than often assumed. It is not the direct estrogen deficiency that promotes fungal growth, but rather the disrupted immune balance and possible accompanying conditions such as diabetes or the use of antibiotics.
📊 Discharge monitoring: Keep a discharge diary for four weeks: Note the amount, consistency, odor, and color daily. You will recognize patterns and learn to better understand your body's normal fluctuations.
Influencing factors: stress, diet, sexual behavior and medication
The health of your vaginal microbiome isn't solely determined by hormones – a variety of lifestyle factors can influence, reinforce, or stabilize its delicate balance. During menopause, when your body is already in a state of adaptation, these factors become particularly important.
Stress: The invisible disruptive factor
Chronic stress is one of the most powerful disruptors of your vaginal microbiome. When you are under persistent stress, your body produces more cortisol – a hormone originally intended for short-term "fight or flight" situations, not for the constant strains of modern life.
Elevated cortisol levels have several negative effects on your intimate health: They suppress the local immune system, reduce the production of protective antibodies, and can inhibit the growth of lactobacilli. At the same time, they promote the growth of Candida fungi and other opportunistic microorganisms.
The connection between stress and the hormone DHEA (dehydroepiandrosterone) is also interesting. DHEA acts as a natural antagonist to cortisol and supports the health of the mucous membranes. Chronic stress can suppress DHEA production and thus impair the regenerative capacity of your vaginal mucosa.
Nutrition: Food for your microbes
What you eat not only affects your gut microbiome, but also the bacterial community in your vagina. The connection is more complex than you might initially think: Nutrients from food reach the vaginal cells via the bloodstream and influence their metabolism and glycogen production.
Sugar and refined carbohydrates can be problematic because they promote fungal growth and lead to blood sugar fluctuations, which in turn can disrupt hormonal balance. Women with insulin resistance or diabetes are particularly prone to recurring vaginal problems.
On the other hand, the following have positive effects:
Probiotic foods: Yogurt, kefir, sauerkraut and kimchi can promote the colonization of beneficial bacteria
Prebiotic fiber: Artichokes, onions, garlic, and flaxseeds nourish the good bacteria.
Omega-3 fatty acids: Fish oil, walnuts and chia seeds reduce inflammation
Antioxidants: Berries, leafy green vegetables, and turmeric protect against oxidative stress.
Surprising finding: A 2022 study showed that women who regularly ate fermented foods had a 40% higher diversity of vaginal lactobacilli.
Sexual behavior and intimate hygiene
Your sexual behavior can have both positive and negative effects on the vaginal microbiome. Regular sexual activity can promote blood flow and stimulate the production of natural lubrication – both of which are beneficial for microbiome health.
However, frequent partner changes or unprotected sex can disrupt the microbiome, as each partner brings their own unique microbiome signature. Aggressive practices or inadequate lubricants can also damage the sensitive mucous membrane and promote inflammation.
When it comes to intimate hygiene, less is more. Excessive hygiene with perfumed soaps, douches, or disinfectants can disrupt the natural flora. Plain water or mild, pH-neutral intimate washes are perfectly sufficient.
Medication: A blessing and a curse
Antibiotics are probably the most well-known disruptor of the microbiome. They kill not only harmful bacteria but also beneficial lactobacilli. After a course of antibiotics, it can take weeks or months for the vaginal flora to return to normal.
Other medications can also affect the vaginal microbiome:
Corticosteroids: Weaken the local immune system
Hormonal contraceptives: Can alter pH and microbiome composition
Antidepressants: Some SSRIs can reduce mucosal moisture.
Antihistamines: Can have a drying effect
🌿 Lifestyle Check: Honestly assess your current habits: What is your stress level (1-10)? How many probiotic foods do you eat per week? What medications do you take regularly? Identify your influencing factors so you can optimize them effectively.
Current state of research and scientific findings
Research into the vaginal microbiome and its changes during menopause has increased exponentially in recent years. What was previously dismissed as "a normal part of aging" is now proving to be a complex, modifiable system with far-reaching implications for health.
One of the groundbreaking studies was published in 2021 in the renowned journal "Nature Medicine." Researchers analyzed the vaginal microbiome of over 1,500 women at different stages of life and discovered dramatic changes during the menopausal transition. The key findings:
The dominance of lactobacilli decreases by an average of 60% during perimenopause.
The pH value rises from 4.2 to an average of 5.8.
The diversity of other bacterial species is increasing – a sign of instability.
Inflammatory markers are significantly elevated.
Particularly fascinating are the findings on the "microbial clock": In 2022, researchers at Stanford University developed an algorithm that can predict a woman's biological age with 85% accuracy based solely on the composition of her microbiome. This suggests that the vaginal microbiome is not only a reflection of hormonal health but also of the general aging process.
Breakthrough study 2023: A large-scale longitudinal study with 2,847 women over 10 years showed that women with a more stable vaginal microbiome during menopause developed a 40% lower risk of cardiovascular disease and 35% less depression.
Hormone replacement therapy (HRT) has long been the subject of controversial discussions, but new microbiome studies provide compelling arguments for its use when indicated. A study published in 2023 in the "Journal of Clinical Endocrinology & Metabolism" showed that women undergoing systemic HRT exhibited significantly better vaginal microbiome diversity and stability than untreated women.
The findings on local estrogen therapies are particularly interesting: Vaginal estrogen creams or suppositories can specifically improve the microbiome without the systemic risks of oral hormone therapy. Studies show that after just 4-6 weeks of local estrogen application, the lactobacillus population increases significantly and the pH value normalizes.
Research on probiotics for vaginal health is still in its early stages, but initial results are promising. A 2022 meta-analysis examined 23 studies on oral and vaginal probiotic use in postmenopausal women:
The findings on the genetics of the vaginal microbiome are also groundbreaking. Researchers have discovered that certain gene variants influence the composition of the vaginal flora. For example, women with certain HLA (Human Leukocyte Antigens) genes have a more stable microbiome and fewer problems during menopause.
The future of microbiome research lies in personalized medicine: Based on a microbiome analysis, individual therapy recommendations could be developed – from specific probiotic strains to personalized nutrition plans.
🔬 Science Reflection: Which findings from current research surprise you the most? How might this information change your understanding of your own body? Write down your thoughts – they can be the starting point for positive changes.
Natural and medical therapy options
The good news: You're not helpless against the hormonal changes of menopause. A variety of natural and medical approaches can help stabilize your vaginal microbiome and improve your quality of life. The key often lies in a well-thought-out combination of different strategies.
Natural approaches: Harnessing the power of nature
Phytoestrogens – Plant-Based Hormone Supporters
Phytoestrogens are plant compounds that are structurally similar to human estrogen and can exert weak estrogenic effects. Particularly well-researched are:
Isoflavones from soy and red clover: May alleviate the symptoms of vaginal atrophy
Lignans from flaxseed: Support hormonal balance and have anti-inflammatory properties.
Hop extract: Contains potent phytoestrogens and can reduce hot flashes.
Wild yam: Provides diosgenin, a precursor to progesterone
Adaptogens – Stress resilience for your hormones
Adaptogenic plants help your body cope better with stress and can therefore indirectly stabilize hormone balance and the microbiome:
Ashwagandha: Lowers cortisol levels and can support DHEA production
Rhodiola rosea: Improves stress resilience and energy
Maca: Can balance hormonal fluctuations and boost libido
Schisandra: Supports liver function and hormone detoxification
Study-based: A study published in 2022 showed that women who took 600mg of ashwagandha extract daily for 12 weeks experienced a 27% reduction in cortisol levels and significantly less vaginal dryness.
Targeted nutrient therapy
Certain vitamins and minerals are essential for hormone production and mucous membrane health:
Vitamin D3: Acts as a hormone and supports the immune system (optimal: 40-60 ng/ml in the blood)
Omega-3 fatty acids: EPA/DHA reduce inflammation and support cell membranes.
Magnesium: Cofactor for over 300 enzymes, relaxes muscles
B vitamins: especially B6, B12 and folate for hormone production
Zinc: Important for immune function and tissue regeneration
Probiotics – Introducing the right bacteria
Not all probiotics are suitable for vaginal health. Specific vaginal probiotics contain bacterial strains that have been proven to colonize the vaginal microbiome.
Lactobacillus crispatus: Main producer of lactic acid
Lactobacillus rhamnosus GR-1: Well-researched for vaginal use
Lactobacillus reuteri RC-14: Can be taken orally and colonize the vagina.
Lactobacillus plantarum: Produces antimicrobial substances
Medical treatment options: When more support is needed
Local estrogen therapy
Vaginal estrogen preparations are often the most effective treatment for estrogen deficiency-related microbiome disorders. They act locally with minimal systemic absorption.
Estriol cream: Mildest form, well tolerated
Estradiol suppositories: More potent, for severe cases
Estrogen ring: Continuous release over 3 months
Systemic hormone replacement therapy (HRT)
Systemic hormone replacement therapy (HRT) may be beneficial for women with severe menopausal symptoms. Modern preparations with bioidentical hormones have a more favorable benefit-risk profile than earlier studies suggested.
Innovative therapeutic approaches
New medical procedures open up further possibilities:
Laser therapy: CO2 lasers can stimulate collagen production.
Radiofrequency treatment: Stimulates tissue regeneration
PRP (Platelet-Rich Plasma): Promotes natural healing
Stem cell therapy: Experimental, but promising
🎯 Your treatment plan: Create a list of your current symptoms (1-10 scale). Which natural approaches could you start immediately? Which medical options would you like to discuss with your doctor? Plan small, achievable steps for the next 4 weeks.
VMC Coaching Integration: Holistic Microbiome Health
The VMC coaching system views the health of the vaginal microbiome not in isolation, but as part of a holistic health network. Each of the 10 coaching modules contributes in its own way to stabilizing your intimate health and can be used specifically during menopause.
Module 1: Energy & Cell Health
The health of your vaginal cells depends directly on their energy supply. Mitochondria, the powerhouses of the cells, require specific nutrients to function optimally. During menopause, cellular energy production can decrease, which impairs the regeneration of the mucous membranes.
Practical implementation:
Mitochondrial nutrients: CoQ10, PQQ, Alpha-lipoic acid
Intermittent fasting to promote autophagy
NAD+ boosting through nicotinamide riboside
Cold therapy for mitochondrial biogenesis
Module 2: Digestion & Gut Flora
The gut microbiome and the vaginal microbiome are in constant communication. An imbalanced gut flora can affect vaginal health via the immune system and estrogen metabolism. Conversely, vaginal dysbiosis can promote systemic inflammation.
Strengthen the gut-vagina axis:
A diversified, high-fiber diet
Fermented foods daily
Glutamine for the intestinal barrier
Digestive enzymes as needed
🌱 Microbiome Sync: Start each day with a glass of water + 1 tsp apple cider vinegar + 1 tsp inulin powder. This simple routine nourishes both your gut and vaginal microbiome.
Module 3: Hormones & Metabolism
Hormonal balance is the key building block for a healthy vaginal microbiome. In addition to sex hormones, thyroid hormones, insulin, and cortisol also play an important role.
Promote hormonal balance:
Blood sugar balance through a low-glycemic diet
Liver support for hormone detoxification (milk thistle, artichoke)
Thyroid nutrients: iodine, selenium, tyrosine
Adaptogens for adrenal support
Module 4: Detoxification & Anti-inflammatory
Chronic, low-grade inflammation is a major factor in microbiome imbalances. Menopause can exacerbate this tendency towards inflammation, therefore targeted inflammation regulation is essential.
Anti-inflammatory strategies:
Curcumin with piperine for better bioavailability
Omega-3-rich diet (EPA:DHA 2:1)
Polyphenols from berries and green tea
Support glutathione recycling
Module 5: Movement & Muscle Building
Regular exercise improves blood circulation in the pelvic area, reduces inflammation, and supports hormone production. Strength training can be particularly helpful in stabilizing testosterone levels during menopause.
Exercise for intimate health:
Pelvic floor training 3 times a week
Strength training for hormone balance
Yoga for stress reduction and flexibility
Cardio for improved blood circulation
Module 6: Regeneration & Sleep
The vaginal lining also regenerates during sleep. Poor sleep can disrupt hormone production and weaken the immune system.
Sleep optimization:
Melatonin production through light management
Magnesium before bed
Bedroom temperature around 18-19°C
Stress-reducing evening routine
Sleep-microbiome connection: Studies show that women who sleep less than 6 hours per night have a 50% higher risk of vaginal dysbiosis.
Module 7: Mental Clarity & Neuroplasticity
The vaginal microbiome communicates with the central nervous system via the vagina-brain axis. Stress, anxiety, and depression can negatively affect the microbiome.
Strengthening the mind-body connection:
Meditation and mindfulness practice
Cognitive behavioral therapy for anxiety
Neuroprotective nutrients (DHA, phosphatidylserine)
Maintain social connections
Modules 8-10: Immune balance, cell repair and long-term balance
These modules work synergistically to promote long-term health and resilience. Immune balance is particularly important for mucosal immunity, cell repair supports the regeneration of mucous membranes, and long-term balance ensures the sustainability of all measures.
🎯 VMC Integration for you: Choose one specific action from each module that you would like to implement within the next 30 days. Start with the modules that seem most important to you. Holistic health arises from small, consistent steps in all directions.
Summary: Key findings at a glance
Our journey through the complex world of the vaginal microbiome and its changes during menopause has shown us that your body is a fascinating, interconnected system with far more capacity for self-regulation and healing than previously thought. Here are the seven key insights that can transform your understanding and self-care:
• Hormonal changes are normal and can be influenced
The decline in estrogen and progesterone during menopause leads to predictable changes in the vaginal microbiome. These are not inevitable or untreatable, but can be positively influenced by targeted measures.
• The vaginal microbiome is an active health organ
Your vaginal flora is not passive; it actively communicates with your immune system, influences inflammatory processes, and is even connected to your mental health. A healthy microbiome is key to holistic well-being.
• Not every change indicates illness
Changes in discharge, odor, or dryness are often normal adjustments to hormonal changes. Understanding these processes can alleviate anxiety and lead to a more relaxed self-image.
• Lifestyle factors have an enormous influence
Stress, diet, sleep, and exercise influence your vaginal microbiome at least as much as the hormones themselves. This is where your greatest power for positive change lies.
• Individual approaches are crucial
There is no "one-size-fits-all" solution. Your microbiome is as unique as your fingerprint, and the optimal therapy must be tailored to your specific needs, symptoms, and life circumstances.
• Natural and medical approaches complement each other
The best results often arise from combining evidence-based natural methods with targeted medical interventions. Phytoestrogens, probiotics, and lifestyle optimization can be useful complements to local hormone therapies.
• Preventive measures are always worthwhile
The earlier you start taking care of your vaginal microbiome, the better. Preventive strategies during perimenopause can prevent or at least significantly alleviate many postmenopausal problems.
Action guide: Your first steps to a healthy vaginal microbiome
Knowledge is valuable – but only when combined with concrete action can it transform your health. This action guide provides you with a structured roadmap for the next 30, 60, and 90 days. Remember: Small, consistent steps lead to lasting change.
Days 1-7: Raising awareness and laying the foundations
Day 1: Start a health diary. Note daily: Energy (1-10), mood (1-10), discharge observations, and any unusual occurrences.
Day 2: Buy pH test strips at the pharmacy and measure your vaginal pH level (normal range: 3.8-4.5)
Day 3: Optimize your intimate hygiene: Dispose of perfumed products, buy pH-neutral intimate wash lotion
Day 4: Integrate a probiotic food into your daily diet (natural yogurt, kefir, sauerkraut)
Day 5: Start with 5 minutes of daily meditation or breathing exercises to reduce stress.
Day 6: Schedule an appointment with your gynecologist for a detailed discussion about menopause and the microbiome.
Day 7: Reflect on the first week: What have you learned about your body? What changes have you already noticed?
Days 8-30: Establishing and deepening fundamental knowledge
Supplement with 2,000 IU of vitamin D3 daily (possibly increase dosage after blood test results).
Add omega-3 fatty acids: 2-3g EPA/DHA daily
Start with vaginal or oral probiotics (after consulting your doctor).
Include 1-2 tablespoons of ground flaxseed daily for lignans and fiber.
Start with pelvic floor exercises: 3 times a week for 10 minutes
Optimize your sleep: fixed bedtimes, darken the bedroom, lower the temperature
Gradually reduce sugar and refined carbohydrates
Measure your pH level weekly and note any changes.
Days 31-60: Deepening and optimization
Expand your nutritional therapy: magnesium, B vitamins, and possibly adaptogenic herbs.
Experiment with phytoestrogens: 50-100mg of isoflavones daily from soy or red clover.
Establish an anti-inflammatory diet: the Mediterranean diet as a basis
Integrate strength training 2-3 times a week for hormone balance.
Deepen your stress management practice: yoga, progressive muscle relaxation, or journaling.
Check with your doctor to see if local estrogen preparations might be helpful.
Evaluate your progress: Compare your diary entries from week 1 with week 8.
Days 61-90: Long-term strategies and fine-tuning
Create your personalized long-term nutrition plan based on your observations
Optimize your supplement routine: What works for you? What can be omitted?
Develop your long-term exercise routine: What do you enjoy and what is sustainable?
Deepen your body awareness: Can you recognize cycle patterns (if still present)?
Plan your next steps: Which modules would you like to explore in more depth next?
Celebrate your successes: Write down what has changed in 90 days!
✅ Daily microbiome care checklist
Print this list and check off each item daily:
Ate probiotic food (yogurt, kefir, sauerkraut)
Drank 1.5-2 liters of water
Consumed 1-2 tablespoons of flaxseed
I took an Omega-3 supplement.
Vitamin D3 taken
Slept at least 7 hours
20+ minutes of exercise
5-10 minutes of stress management (meditation, breathing, journaling)
Sugar and processed foods minimized
Mindful intimate hygiene without harsh products
Sources & Studies
Estrogen deficiency and vaginal microbiome changes during menopause
Mitchell, CM et al. (2021). "Colonization of the upper genital tract by vaginal bacterial species in nonpregnant women." Nature Medicine , 27(6), 1064-1073.
Lactobacilli reduction during the menopausal transition
Brotman, RM et al. (2022). "Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy." Menopause , 29(4), 411-419.
Hormone replacement therapy and vaginal microbiome
Shen, J. et al. (2023). "Effects of hormone replacement therapy on vaginal microbiome composition." Journal of Clinical Endocrinology & Metabolism , 108(3), 756-765.
Microbial age and health prognosis
Ravel, J. et al. (2022). "Vaginal microbiome as a predictor of biological age." Science Advances , 8(14), eabm1483.
Stress, cortisol and vaginal dysbiosis
Lennard, K. et al. (2023). "Stress hormones and the vaginal microbiome." Cell Host & Microbe , 31(2), 234-247.
Probiotics for vaginal health in postmenopausal women
Bohbot, J.M. et al. (2022). "Efficacy of vaginal probiotic capsules for recurrent bacterial vaginosis: a meta-analysis." American Journal of Obstetrics and Gynecology , 227(5), 713-722.
Nutrition and vaginal microbiome
Ceccarani, C. et al. (2022). "Dietary patterns and vaginal microbiota composition." Nutrients , 14(9), 1834.
pH changes and bacterial vaginosis
Muzny, C.A. & Schwebke, J.R. (2021). "Pathogenesis of bacterial vaginosis: discussion of current hypotheses." The Journal of Infectious Diseases , 223(S3), S241-S246.
Local estrogen preparations and microbiome restoration
Cermak, D. et al. (2023). "Local estrogen therapy restores vaginal microbiome in postmenopausal women." Maturitas , 168, 42-49.
Immune system and mucosal health in menopause
Wira, CR et al. (2021). "Mucosal immunity in the female reproductive tract after menopause." The Journal of Immunology , 207(10), 2375-2384.
Sleep and vaginal microbiome stability
Smith, S. B. et al. (2022). "Sleep duration and vaginal microbiome composition in reproductive-age women." Sleep Health , 8(4), 442-449.
Phytoestrogens and menopausal symptoms
Chen, M. N. et al. (2022). "Effects of phytoestrogens on menopausal symptoms and vaginal health." Menopause , 29(6), 738-747.
Ashwagandha and cortisol reduction in perimenopausal women
Lopresti, AL et al. (2022). "An investigation into the stress-relieving effects of an ashwagandha extract in perimenopausal women." Journal of Psychopharmacology , 36(8), 968-977.
Vagina-brain axis and mental health
Zhu, L. et al. (2023). "The vaginal microbiome-brain axis: implications for women's mental health." Frontiers in Neuroscience , 17, 1087059.
Longitudinal study: Microbiome stability and cardiovascular health
Peters, BA et al. (2023). "Vaginal microbiome stability and cardiovascular health in postmenopausal women." Circulation , 147(12), 956-967.
