Bacterial vaginosis (BV) occurs when there’s an imbalance in the normal bacteria that usually populates the vagina. And while a hormonal imbalance is not typically the primary cause of BV, normal hormonal changes (like those we experience during our period, pregnancy or perimenopause) can be a factor in getting BV. The reason? Studies show that fluctuations in our hormones may change the bacterial makeup of the vagina.

In fact, a study out of the Department of Genitourinary Medicine of The General Infirmary at Leeds, UK, notes that “hormonal changes may be important in the onset and clearance of bacterial vaginosis”.

What Does It Mean to Have a Hormonal Imbalance?

Our bodies are made up of a variety of complex systems. One of these systems is the endocrine system, which is a “collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction and many other things”. Hormones are chemicals that travel through the bloodstream and give messages to various other bodily systems about what to do and when to do it.

Because hormones regulate so many things in the body, hormonal imbalances can cause a wide variety of symptoms. Some of these symptoms include unexplained weight gain or loss, unexplained sweating, difficulty sleeping, changes in sensitivity to cold and heat, infertility, reduced sex drive, long-term fatigue, and changes in appetite.

In men, the primary sexual hormone that is affected by hormonal imbalance is testosterone, whereas in women, it’s either estrogen, progesterone, or both.

There are certain times in life in which women are particularly prone to possible hormonal imbalances. If you’re wondering what causes hormonal imbalance, it may have to do with a life change such as puberty, menstruation, pregnancy, childbirth, breast-feeding, perimenopause, menopause, or postmenopause. Women may also develop conditions like polycystic ovary syndrome (PCOS), early menopause, primary ovarian insufficiency (POI), or ovarian cancer that can affect their hormonal balance. In addition, taking hormonal birth control can affect hormonal balance in women.

Symptoms of Hormonal Imbalance in Women

If you’re wondering if you might be suffering from some kind of hormonal imbalance, ask yourself whether you’re going through one of the life events listed above that can cause hormonal imbalance. Also look out for symptoms such as:

• Heavy, irregular, or painful periods
• Hot flashes
• Vaginal dryness
• Breast tenderness
• Weight gain
• Changes in sex drive

If you are worried about hormonal imbalance, you can practice some self-care techniques, such as limiting sugary foods and refined carbohydrates, exercising regularly, and buying pesticide-free food. If issues are ongoing, please talk to your healthcare provider about how your hormones may be affecting you.

Causes of Hormonal Imbalances

For people with uteruses, the two primary hormones that fluctuate throughout one’s life are progesterone and estrogen. These two hormones have a complex relationship with one another and aren’t always perfectly balanced. In fact, in the normal menstruation cycle of a healthy woman under the age of 40, the first half of a woman’s cycle is characterized by estrogen dominance, whereas the second half of the cycle is characterized by progesterone dominance. In perimenopausal and menopausal women, some of the hormonal imbalance has to do with eggs of mixed quality, causing the hormonal output to be inconsistent.

As mentioned above, hormonal imbalance can be caused by a wide variety of things. Some of the primary causes of hormonal imbalance in women include:

• Diabetes
• Medications
• Stress
• Injury or trauma
• Adrenal insufficiency
• Pregnancy
• Breastfeeding
• Menopause
• Hormonal birth control
• Puberty

What Is Bacterial Vaginosis?

If you’ve never had it, you may be wondering “what is BV?” Bacterial vaginosis (BV) is actually very common amongst women between the ages of 15 and 44. In fact, it is considered one of the most common vaginal infections amongst women of childbearing age. Over 3 million women in the United States alone are diagnosed each year.

Causes

Bacterial vaginosis is essentially an overgrowth of bad bacteria in the vagina. To understand how this bacteria takes over, it’s helpful to understand how the normal vaginal microbiome functions.

Women’s vaginas normally produce an array of lactobacilli (or good bacteria), which in turn create the lactic acid needed for healthy bacteria to multiply and thrive. This is important because vaginas function optimally at an acidic pH of 3.8–4.5, and the lactic acid created by healthy lactobacilli guarantees a well-balanced vaginal environment. Unfortunately, this balance can be disrupted by an overgrowth of Gardnerella vaginalis. These bacteria thrive in a less acidic environment. So if the acidity of the vagina changes, these Gardnerella bacteria can take over. When lactobacilli are outnumbered, they are unable to fight off the bad bacteria like they normally do, leaving you much more susceptible to vaginal infections like bacterial vaginosis.

So now you know what bacterial vaginosis is. But what exactly happens to get our vaginas in such a susceptible state? The vaginal ecosystem thrives when the pH is at a fairly acidic level (3.8–4.5). In this acidic environment, healthy lactobacilli bacteria can reach optimal levels, keeping you feeling fresh and balanced down there. Unfortunately, this ecosystem can be easily thrown off by a variety of factors, such as douching, sex with new partner or more than one partner, smoking, or using any deodorizing products in your vaginal area. All of these things can change the vaginal biome, potentially putting you at a higher risk for contracting bacterial vaginosis.

Symptoms

While it’s possible and common for women to contract BV and not have any symptoms, the most common BV symptoms in women include:

• Vaginal discharge that is white or gray in color
• Vaginal itching
• Painful or burning urination
• Discharge with a strong, fishy odor — especially odor after sex

If you’re concerned that you may have contracted bacterial vaginosis, are feeling off, or are experiencing any of the symptoms mentioned above, please contact your healthcare provider or gynecologist.

How to Get Rid of BV

Most commonly, bacterial vaginosis is easily diagnosed and treated with a round of antibiotics prescribed by your healthcare professional. These antibiotics are given either orally or as a suppository inserted vaginally. Common antibiotics given for bacterial vaginosis include metronidazole, clindamycin, and tinidazole.

Why Your Infection Might Recur

Unfortunately, despite antibiotic treatment, it is possible for bacterial vaginosis to recur. What causes this? According to a study out of the Department of Genitourinary Medicine of The General Infirmary at Leeds, UK, predisposing factors for recurring BV include younger age, African-American ethnicity, douching, smoking, and the use of an IUD. While many papers link the number of sexual partners to a risk for recurring BV, this study found the introduction of a new sexual partner to be more closely correlated with recurring BV than just the total number of partners. While this study also looks into whether it’s reinfection or relapse that causes bacterial vaginosis to recur, scientists and doctors are still at the beginning of investigating the cause behind the rates of recurrence of bacterial vaginosis.

If you currently have or have had chronic bacterial vaginosis, you might be wondering how to stop recurring BV infections permanently. Normally, it is recommended to continue antibiotic treatment. Your doctor might put you on low-dose, long-term antibiotics to keep the infection at bay while you recover. However, there is a risk that the bacteria involved may become resistant to antibiotics. In addition, the bacteria that cause bacterial vaginosis may collect in vaginal biofilms where antibiotics can’t reach them, and then regrow after the treatment is over.

In the Leeds study previously mentioned, some alternative therapies may be available to stop recurring BV infections permanently. Some of these treatments include bacteriotherapy, which is using harmless bacteria to displace the bad bacteria. Another is maintaining a low vaginal pH by using intravaginal lactate gel. Finally, the study authors recommend utilizing a combination of treatments in order to stop recurring BV.

Ways to Prevent BV

Whether you’ve had bacterial vaginosis before or are hoping to avoid the experience altogether, here are some tips on how to prevent BV.

Avoid douching or using any scented products in or around the vaginal area. Deodorized products often upset the balance of healthy bacteria in the vagina. Plus, the vagina is generally self cleaning, so scented products are unnecessary. Also make sure to avoid scented tampons or pads.

Practice good hygiene and allow your vagina to breathe. Try wearing cotton underwear, changing your pads or tampons every few hours, and avoiding your vagina staying wet for long periods of time.

Use condoms if you’re worried about a new partner or the impact of unprotected sex on your vaginal pH. 

Incorporate a vaginal probiotic into your daily supplement intake. While the science is still new, these can help maintain a healthy environment for the good vaginal bacteria to thrive.

Conclusion: Yes, Hormone Imbalance Can Indirectly Cause BV

Bacterial vaginosis is caused by an overgrowth of bad bacteria G. vaginalis in the vagina. It may arise when the vaginal environment changes from being overall acidic at a 3.8–4.5 pH, so that the good lactobacilli bacteria can no longer thrive. While hormonal imbalance can be a factor in this change in vaginal flora, it is only one of many factors that can predispose someone to getting BV.

In order to prevent BV, it is recommended to practice good vaginal hygiene, take vaginal probiotics, and practice safe sex.