Have you had it yet? If you haven't, congratulations, I never, ever got BV until menopause. 

But we all can get bouts of it at different times in our lives. 

At first it can just feel like irritation. Nothing major. But then symptoms escalate and you find that you have a raging case of Bacterial Vaginosis. What can you do? It’s uncomfortable and painful.

Personally, BV is something that is better to prevent than treat. 

In perimenopause and menopause we all get used to “things” happening to our bodies that are uncomfortable. So we tend to ignore the small first symptoms. 

There is the one moment that you sit down to go pee and smell yourself and it’s a little fishy. 

After the fishy smell, is when the irritation, burning and discomfort become noticeable. Then you might even feel a little burning when pee. 

In a short while you’ll discover that you have a full blown Bacterial Vaginosis - BV situation. 

For many that’s how it starts out. 

And as things progress with BV you’ll notice that it is reoccurring. You’ll start to get more and more incidents of it. The doctor will prescribe either the pill or vaginal cream. For many it solves the issue within a few days. 

I have tried the pills and the cream. And honestly each one comes with its own set of B.S. 

The cream applicator is downright painful, especially when your areas are already inflamed and irritated. I joked with my husband that a man must have designed it because it is the rudest thing I have experienced. The edges are squared off, so insertion becomes extremely unpleasant. 

And the pills don’t make you feel all that great, even though it helps out the B.V. 

So for me it was a mission to figure out what worked the best to prevent instead of just treating with prescription medication. 

Have you had bacterial vaginosis more than once in the past year or two and started wondering if something is just wrong with you? Why am I getting it over and over again? 

Maybe I'm not using the right soap in the shower. 

Maybe it's stress. 

Maybe it's my diet and I’m eating something that’s causing this. 

What am I doing wrong?

I hear this all the time. And I want to be really clear with you: you are not dirty, you are not doing anything wrong, and you are absolutely not imagining it. If BV has become a recurring guest in your life since you hit your 40s or 50s, there is a very real, very physiological reason why,  and it has everything to do with what perimenopause and menopause are doing to your body right now.

The problem is not you. The problem is a shift in your hormonal environment that quietly changes the conditions inside your vagina, and most women don't find out about that connection until they've already been through multiple rounds of antibiotics, wondering what they're doing wrong.

Today we're going there. All of it. 

Why perimenopause and menopause set the stage for BV, what's actually happening inside your body, what the medical options look like, and what you can do at home to change the conditions that keep inviting BV back.

Here's the thing about BV — it gets treated like it's a hygiene problem or an STI, and it is neither.

 Bacterial vaginosis is a disruption in the bacterial balance of the vaginal microbiome. Specifically, it's what happens when the healthy lactobacillus bacteria that normally dominate the vaginal environment get outnumbered by other bacteria like Gardnerella vaginalis or Prevotella.

What nobody tells you is that estrogen is the reason healthy lactobacillus thrives in the first place. Estrogen keeps vaginal tissue thick, moist, and slightly acidic — the kind of environment where Lactobacillus is happy and where the bacteria that cause BV struggle to get a foothold.

When estrogen starts dropping in perimenopause — which can begin years before your last period — the vaginal environment shifts. The tissue gets thinner and drier. The pH rises. The acidity that protected you from bacterial overgrowth starts to fade. And suddenly you're more vulnerable to BV than you've ever been in your life.

The system fails women here in two ways. First, providers often treat BV as a standalone infection without ever mentioning the hormonal context. Second, most of the public conversation around BV still frames it as a sexual health issue for younger women — leaving midlife women completely out of the picture, confused, and embarrassed to even bring it up.

You're not uniquely susceptible to infections. Your body is working through a massive hormonal transition, and BV is one of the downstream effects that doesn't get talked about nearly enough.

Vaginal & Hormonal Signs

The Bigger Pattern You're Living With

Emotional & Mental Weight

Here's the typical experience. 

You go in, you describe the discharge and the odor, you get a pelvic exam and a swab. The results come back positive for BV, you get metronidazole or clindamycin, you take the full course, things clear up — and then a short while later you're back in the same office with the same symptoms.

What usually happens next is you get another prescription. Occasionally a referral to a gynecologist if your primary care provider is at a loss. But rarely, almost never, in my experience talking to women going through this, does anyone sit down with you and say: 'Let's talk about where you are in perimenopause and what that's doing to your vaginal environment, because that's probably why this keeps coming back.'

The hormonal picture gets missed for a few reasons. These days doctor appointments are short. I like to call it “Speed Appointments”. In fact a doctor that I talked to referred to working at the hospital as a “factory”. So you get the drift, doctors are being pushed to see as many people as possible during their shift. 

BV looks like a straightforward infection on paper. And the connection between declining estrogen and vaginal microbiome disruption is genuinely underappreciated in many clinical settings outside of specialized menopause care.

What's often being missed: the vaginal pH that's fueling recurrent BV. The fact that treating the infection without addressing the underlying hormonal environment is a bit like mopping up a leak without turning off the water. And the very real option of vaginal estrogen — a low-dose, locally-applied treatment that restores the vaginal environment and dramatically reduces recurrence risk for many women — that never gets mentioned.

Your frustration is completely warranted. Recurrent BV in perimenopause is not a personal failing. It is a medical pattern with a clear physiological explanation and real treatment options. You deserve to have that conversation.

Here are some questions you can literally read from your notes app. You don't have to remember them or find the right words in the middle of a rushed appointment. Just pull these up and say: 'I wrote some things down that I wanted to ask about.'

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If you've had BV three or more times in the past year and the conversation at your appointments hasn't moved beyond prescriptions, it's a reasonable time to widen your care team. That's not a criticism of your provider — it's just a recognition that recurrent BV in the context of perimenopause or menopause is a specialized topic, and some providers are better equipped to address it than others.

There are gynecologists, certified menopause practitioners, and integrative health providers who really understand the hormonal-microbiome connection and can offer a more complete picture of what's driving the recurrence and what the realistic treatment options are for you specifically.

SIGNS IT MAY BE TIME TO SEEK ADDITIONAL SUPPORT:

PROVIDERS WHO MAY BE HELPFUL:

1. Ditch the fragranced products — all of them

Scented soaps, bubble baths, douches, and even some fabric softeners on underwear can disrupt vaginal pH. Switch to unscented soap for external washing only and stop using anything inside. Your vagina is self-cleaning. It does not need products. If this feels hard because you're worried about odor — that's the BV talking, not the hygiene problem.

2. Try a vaginal probiotic — specifically one with Lactobacillus strains

Look for probiotic supplements specifically formulated for vaginal health, containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. These two strains have the best evidence for supporting vaginal microbiome balance. You can take them orally. Some women also use general Lactobacillus acidophilus capsules vaginally between BV episodes — ask your provider if that approach makes sense for you.

Note: Supplements are not a substitute for medical treatment, and you should discuss options with your healthcare provider before adding new supplements to your routine.

3. Look at what you're eating this week

High sugar intake feeds the bacteria that cause BV. This week, just notice how much added sugar you're consuming and whether there's one easy swap you can make. More fermented foods — plain yogurt, kefir, kimchi, sauerkraut — support your gut microbiome in a way that indirectly supports vaginal health too.

4. Wear breathable underwear and sleep without it when you can

Synthetic fabrics and tight clothing trap heat and moisture, creating an environment where the wrong bacteria thrive. Cotton underwear and going without underwear at night can make a meaningful difference. It's a small thing that costs nothing.

5. Start tracking your symptoms for 30 days

Before your next appointment, keep a simple note on your phone: date, any symptoms (discharge, odor, dryness, itching), where you are in your cycle if you still have one, and anything that seemed to precede a flare. This kind of pattern tracking gives your provider actual data to work with and makes the recurrence pattern visible in a way that's hard to ignore.

Truth: BV is a disruption in vaginal bacteria balance — the same way your gut can get out of balance. Cleanliness has nothing to do with it, and over-washing actually makes it worse by stripping the good bacteria.

Truth: BV is not an STI. While sexual activity can be a trigger, it also occurs frequently in women with no sexual partners. In perimenopause and menopause, declining estrogen is often the primary driver — sex life is beside the point.

Truth: Antibiotics treat the episode, not the underlying environment that allowed it to happen. Without addressing vaginal pH, estrogen levels, and microbiome balance, recurrence rates after antibiotic treatment are high — some studies show over 50% within a year.

Recurrent BV in perimenopause is one of those things that can quietly chip away at your confidence and your comfort in your own body. You deserve to understand what's driving it, and you deserve a conversation that goes beyond 'here's another prescription.' I hope this gives you some of the language and knowledge to start that conversation.

Take what resonates. Leave what doesn't. And know that whatever you're experiencing is real and worth taking seriously.

Take care,

Inci

Her Side of Health

MEDICAL DISCLAIMER

This newsletter is for education and information, not medical advice. It's not a substitute for a relationship with a qualified healthcare provider who knows your history. Please use what resonates here to spark better questions and conversations with your health care provider, and more collaborative care with your own health care team.

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