What is the best probiotic for vaginal health?

Probiotics and vaginal health | Types of probiotics | Choosing a probiotic | Optimizing vaginal health | FAQs | The bottom line | Sources

Probiotics for gut health and improved host immunity recently became a trending health topic. Probiotics are beneficial live microorganisms that colonize the body and play a role in the composition of that environment’s microbiota to improve the overall health of the host. Common microorganisms used as probiotics are Lactobacillus species, Bifidobacterium species, and yeast as Saccharomyces boulardii. Another health topic of interest is the use of probiotics to regulate the composition of microorganisms in microbiota. In the digestive tract, a healthy flora can maintain the integrity of the mucosal barrier, an essential component of our innate immune system that provides nutrients and resists pathogens. Overall, immune system modulation has many health benefits. 

For these reasons, probiotics have established a role in digestive health for disorders like ulcerative colitis and irritable bowel syndrome. More studies are beginning to demonstrate benefits on immune function outside the gut microbiome. Probiotics have been shown to play a role in managing chronic inflammatory diseases and benefit those with chronic conditions like diabetes. With such promising information, probiotic effects on other microbiotas are of interest-including the benefit in women’s health, specifically overall vaginal health. Probiotics can be consumed through fermented food, enriched foods, and supplements. With hundreds of strains with different benefits, it is important to understand the best probiotic strains to promote one’s unique needs, including a healthy vagina.    

Probiotics and vaginal health

The most common microorganism in the female reproductive tract is Lactobacillus species, including Lactobacillus acidophilus, L. rhamnosus, and L. reuteri. Lactobacillus presence helps the vaginal mucosal barrier by adhering to the epithelium lining the vagina and antagonizing the colonization of pathogenic microorganisms. Other microorganisms that make up a minority of the healthy vaginal flora include Bifidobacteria, Gardnerella, Megasphera, and Prevotella. Probiotics may play an important role in many areas of women’s health since they maintain the stability of the vaginal microbiota. Vaginal imbalances in the flora can result in gynecological diseases, including cervical cancer due to infection with Human Papillomavirus (HPV), genitourinary symptoms of menopause, urinary tract infections, and vaginal infections like bacterial vaginosis and vulvovaginal candidiasis (vaginal yeast infection). 

Probiotics improve vaginal health in the prevention of infections by production of substances like lactic acid and hydrogen peroxide. These substances decrease the vaginal pH and make it more acidic, such that pathogens cannot overgrow and cause infection. When bacteria that produce these acids maintain an acidic pH and deplete, pH levels neutralize and support an environment more inviting for pathogenic bacteria or yeast to thrive. 

Bacterial vaginosis is an umbrella term for infectious diseases caused by an imbalance in the normal flora of the vagina, generally from a decrease in Lactobacillus and an increase in Gardnerella and Prevotella. It is the most common vaginal infection in women of childbearing age. It has been associated with a 3-month recurrence rate as high as 75%, an increased risk of sexually transmitted infections, premature birth, and other reproductive health sequelae. Common antibiotic treatment with metronidazole is effective, but high recurrence rates remain due to non-selective disruption of the vaginal microbiome. Probiotics can be beneficial in this setting to improve colonization with good bacteria. In one clinical trial, patients with bacterial vaginosis treated with probiotics compared to those who have not demonstrated a significantly reduced recurrence rate and improved cure rate. Similar beneficial outcomes were shown in a meta-analysis of 18 studies with a 3-month follow-up evaluating the combination of antibiotics and probiotics versus antibiotics alone, showing significantly reduced recurrences of bacterial vaginosis in those receiving the combination with probiotics. 

In vaginal yeast infections, which also occur due to an imbalance in the normal vaginal microbiota, combining probiotics with standard antifungal medications may assist in treatment but will not treat a yeast infection by itself. Ongoing use of probiotics after completion of treatment may decrease the risk of relapse as a preventive measure. 

Patients with severely immunocompromising conditions should generally avoid consumption of probiotic supplements, as there is a risk of spillage into the bloodstream, which may result in an active yeast infection. While probiotics are generally safe, and there is minimal evidence suggesting that a person can overdose, it is important to consume them as directed and under the supervision of a healthcare professional.

6 probiotics for vaginal health

Women tend to be more prone to urogenital bacterial imbalances than men, which could be due to differences in anatomy, lifestyle stressors, and diet. Millions of women suffer from urogenital infections that become a recurring issue. A healthy vaginal microbiota plays a protective role. In the following sections, we will discuss the potential benefits of specific strains in a daily routine to maintain a balanced vaginal ecosystem. By nature, a probiotic supplement containing Lactobacillus should be beneficial in maintaining a healthy low vaginal pH through its production of lactic acid. A healthy vaginal microbiota helps maintain an optimal pH level of around 4, with this acidity keeping excessive amounts of bacterial and fungal pathogens at bay. Lactobacillus assists in maintaining in keeping the pH low, which in studies has demonstrated an ability to adhere to cells of the vaginal epithelium and displace vaginal pathogens. Bifidobacterium may have a protective role like Lactobacillus. 

1. Lactobacillus acidophilus

Lactobacillus acidophilus is one of the most researched strains of Lactobacilli when it comes to vaginal health. Different strains of L. acidophilus have demonstrated clinical effects in managing bacterial vaginosis; less data exists for L. acidophilus’ management of vulvovaginal candidiasis than with other Lactobacillus species. L. acidophilus can be found in dietary sources, like yogurt containing live L. acidophilus strains, miso, and tempeh. Supplementary preparation forms include freeze-dried granules, liquid preparations, oral probiotics, and vaginal suppositories.

2. Lactobacillus rhamnosus

L.rhamnosus’ LbV 96 strain has demonstrated improved recovery rates and symptoms of bacterial vaginosis. Strain GR-1 has promising results for both bacterial vaginosis and vulvovaginal candidiasis. 

3. Lactobacillus reuteri

L.reuteri strain RC-14 has demonstrated efficacy in managing bacterial vaginosis and vulvovaginal candidiasis. It is available in a few different commercially available probiotic formulations and is co-formulated with L. rhamnosus strain GR-1.

4. Lactobacillus crispatus

A recent clinical study found that women who inserted a probiotic containing live Lactobacillus crispatus CTV-05, a naturally occurring vaginal strain of L. crispatus, in their vagina twice weekly were less likely to experience a recurrence of bacterial vaginosis than women who did not. Women in this study were treated for bacterial vaginosis with topical metronidazole, a standard antibiotic approach to managing the infection, and then randomized to receive either the probiotic or a placebo. In those that received the probiotic containing L. crispatus, only 30% of women had a recurrence of bacterial vaginosis by week 12 of follow-up versus 45% of women in the placebo group. 

5. Lactobacillus gasseri

Like L. acidophilus, the highest quality data for supplementation with probiotic formulations containing L. gasseri is for managing bacterial vaginosis. Like all Lactobacilli, it protects the vaginal microbiome by stabilizing vaginal pH and killing off pathogenic microorganisms. Specifically, strain LbV 150N is included in commercially available probiotics.

6. Bifidobacterium lactis

A balance of both Lactobacilli and Bifidobacteria species protects against the overgrowth of pathogenic bacteria in the vagina, likely due to the digestive microbiome serving as a reservoir for pathogens which can disrupt the vaginal microbiome-by way of proximity. B. lactis is the most studied species of Bifidobacteria, a powerful probiotic in the gastrointestinal tract able to survive and thrive in other acidic environments like the vagina. It, too, possesses adhesion properties that allow it to adhere to the mucosal layer of its microbiome and disrupt the survival of pathogens. A healthy gut can support a healthy vagina. 

Choosing the best probiotics for vaginal health

With so many strains of live bacteria available in probiotic formulations, it is important to understand which strains have demonstrated benefit against the condition or ailment seeking improvement. When seeking a high-quality probiotic for vaginal health, a product with a combination of Lactobacillus and Bifidobacterum strains is ideal for supporting both vaginal and digestive tract microbiomes. Probiotics containing the following strains are optimal for microbiome balance:

• Lactobacillus acidophilus
• Lactobacillus rhamnosus
• Lactobacillus reuteri
• Lactobacillus crispatus
• Lactobacillus gasseri
• Lactobacillus brevis
• Lactobacillus plantarum
• Lactobacillus paracasie
• Bifidobacterium lactis
• Bifidobacterium longum 

There are additional nuances between formulations that may be important to acknowledge, such as refrigeration, the number of doses required per day, and being produced free of gluten or other allergens. The degree of high-quality data from clinical trials should also be taken into consideration, with the selection of probiotics based on those formulations with the highest level of recommendation. For efficacy in bacterial vaginosis and vulvovaginal candidiasis, the best option based on those criteria is Ultra-Iora Women’s. This probiotic does not require refrigeration, requires 2 capsules per day, and is gluten-free. Jarrow Formulas Fem-Dophilus formulation with 5 billion CFUs/dose requires refrigeration but only requires one capsule per day and is gluten-free. 

Tips for optimizing vaginal health with probiotics

Probiotics can be consumed through fermented foods or dietary supplements, with fermented foods being the most natural source. While there is no recommended daily intake for probiotics, adding as many natural sources to your diet as tolerated is optimal. Fermented foods include yogurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, and sourdough bread. Yogurt is the easiest to add to a diet, given its palatability and ability to substitute ingredients in many baking and cooking recipes. Always look for labeling that specifies “live and active cultures,” as some fermented foods may undergo steps in their processing that remove probiotics. 

Many of these natural sources of probiotics through fermented foods come with a taste and smell that may be too strong for an individual’s palate, so probiotic supplements are an alternative approach. Pay attention to the labeling of the supplement to make sure it is taken and stored as directed. Different probiotics vary greatly in their standard daily recommended doses, and some require refrigeration while others are shelf-stable. Do not take probiotics supplements past their beyond-use or expiration date. Labeling should also provide recommendations on how to take the supplement, with most probiotics containing Lactobacillus or Bifidobacterium strains urging consumption 30 minutes before a meal. 

Probiotics may take some time to achieve the desired effect, so give the increase in probiotics a full month to take its effect, whether through natural sources or supplementation.  

FAQs about vaginal probiotics

Are there side effects to using probiotics for vaginal health?

Probiotics are generally safe with minimal adverse effects in healthy individuals. The most significant risk is to those with weakened immune systems, as there is a chance of contracting an actual infection from the probiotics for them. Immunocompromised individuals should avoid probiotics unless approved by a medical professional. Other side effects one might experience soon after beginning probiotic therapy may include diarrhea or constipation, but these should resolve over time as overall gut health is optimized. It is important to take the probiotic as instructed and at the dose recommended on its packaging. Don’t assume a dose of one probiotic supplement is the same as another; they can vary greatly. 

Can probiotics cure existing vaginal infections?

Probiotics are unlikely to cure an active vaginal infection. However, when consumed with antimicrobial therapy, adjunctive probiotic therapy may contribute to improved outcomes, such as a decreased risk of recurrence of the infection. This can have a significantly positive impact on the healthcare system’s economy and the emotional and social effects that women may experience.  

Can pregnant women use probiotics?

As with all dietary supplements, speak with a healthcare professional before consuming probiotics when pregnant or breastfeeding. In general, probiotics do not appear to pose any safety concerns for pregnant or breastfeeding women, and the current literature does not indicate any increase in adverse outcomes in probiotics consumed by healthy individuals.

The bottom line

Women seeking out probiotics for vaginal health are most likely doing so to ease the discomfort associated with common gynecological conditions like bacterial vaginosis and vulvovaginal candidiasis. Currently, the only proven treatment for either of these conditions is antibiotics or antifungals, but there is promising scientific data to support that probiotic consumption may reduce recurrences. Probiotics containing strains of bacteria, which have the most high-quality data to support this claim, are likely the best products to consume. Still, factors like the daily dose, refrigeration needs, and other considerations require an individualized approach to selecting a probiotic formulation best suited for each woman. Either way, any new vaginal symptoms require evaluation by a healthcare professional. In that meeting, a discussion on the individual pros and cons of probiotic use to support beneficial bacteria and a healthy vagina can occur. Overall, probiotic use seems to be a safe adjunctive therapy to the armamentarium of vaginal health.