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October 16, 2026Vaginal health is one of the least talked about parts of menopause, and one of the most disruptive. Many women tell us they have put up with dryness, irritation, recurrent cystitis or stubborn infections for years, either assuming it is “just part of getting older” or feeling too embarrassed to raise it. It isn’t something you simply have to live with. 
Understanding what is happening in the vaginal microbiome after menopause is the first step to doing something about it.
What is the vaginal microbiome?
Just like your gut, your vagina is home to a community of microbes. In a healthy woman of reproductive age, this community is dominated by Lactobacillus bacteria. They turn sugars into lactic acid, which keeps the vaginal environment acidic, at a pH of around 4.5 or lower. That acidity is a natural defence: it keeps unwanted bacteria and yeast in check and helps protect the urinary tract too.
The key detail is that the fuel for these bacteria, a sugar called glycogen, depends on oestrogen. Oestrogen keeps the vaginal lining thick, moist and well supplied with blood, and it prompts the cells of the lining to store glycogen. So when oestrogen falls, the whole ecosystem is affected.
What happens when oestrogen drops
During perimenopause and after menopause, falling oestrogen sets off a chain of changes:
- The vaginal lining thins and becomes drier and more fragile.
- Less glycogen means fewer protective bacteria, so Lactobacillus declines.
- The pH rises, making the environment more welcoming to other bacteria.
- The microbiome becomes less stable, even if you have no infection at all.
Not every woman is affected in the same way. Factors such as HRT, sexual activity, diet, blood sugar, stress and antibiotic use all play a role, which is why two women of the same age can have very different symptoms.
Vaginal atrophy and GSM
You may have heard of “vaginal atrophy”. The preferred term now is Genitourinary Syndrome of Menopause (GSM), because it affects the urinary tract as well as the vagina. Symptoms can include:
- Vaginal dryness, burning or irritation
- Discomfort or pain during sex
- Urinary urgency, frequency or discomfort
- Recurrent urinary tract infections (UTIs)
- Changes in discharge or odour
Unlike hot flushes, which often settle over time, GSM tends to persist and can gradually get worse without support, because the underlying cause, low oestrogen, doesn’t go away. Many women don’t connect their symptoms to menopause at all, particularly when they start years after periods have stopped
Why UTIs become more common
The urethra and bladder are also oestrogen-sensitive. After menopause, the tissue around the urethra thins and the protective bacteria decline, making it easier for bacteria such as E. coli to move from the gut area into the bladder.
Bacterial vaginosis (BV) and other infections
BV is usually thought of as a problem of the reproductive years, but it can happen after menopause too. It can occur when protective Lactobacillus is lost and other bacteria overgrow. BV can cause a thin grey discharge and a fishy odour, but it can also cause no symptoms at all. It also has a habit of coming back after treatment.
Menopausal women can also develop aerobic vaginitis, an inflammatory imbalance that can feel like thrush or BV but needs a different approach, and thrush itself can still occur. The trouble is that GSM, BV, aerobic vaginitis and thrush can all look very similar from the outside. Women are often treated for one, then another, without lasting relief.
How vaginal microbiome testing can help
Our approach is simple: test, don’t guess. A standard GP swab looks for a limited range of common culprits. That is sufficient for some situations, but it can miss the bigger picture if symptoms persist or keep returning.
Our Vaginal Health Test is an at-home swab that uses PCR (DNA-based) testing to look at your vaginal microbiome in more detail. It shows:
- How much protective Lactobacillus you have
- Your vaginal pH, a key sign of how well your protective bacteria are doing
- Whether bacteria linked to BV and aerobic vaginitis are overgrowing
- Whether Candida (yeast) is involved
For a woman in menopause, this helps us see what is actually going on rather than treating symptoms that look alike, understand how much protective bacteria you have left, and tailor your plan to your own results
Every woman’s picture is different, so we build your plan around your symptoms, your history and your results, working alongside your GP. If you are dealing with dryness, recurrent UTIs, BV or infections that keep coming back, the most helpful next step is to book an appointment so we can look at your individual situation and decide together whether testing and a personalised support plan make sense.
