Just why are probiotics for women important in terms of their benefits to health? A healthy balanced microbiome is important for us all and most of us would benefit from upping our intake of probiotic-rich foods or taking a probiotic supplement. However, women in general have slightly different needs and may require additional probiotic support relating to vaginal, digestive, hormonal and urogenital imbalances.
The microbiome is the genetic material of all the microbes that live on and inside the human body and different parts of the body have distinct communities of microbes. In this week’s blog we will focus on probiotics in relation to women’s health and take a look at some of the different probiotic strains indicated in a range of issues specific to women.
What are the benefits of probiotics for women?
Probiotics promote vaginal health
Like the gut, the vaginal microbiome requires a delicate balance of bacteria to remain healthy and is home to a diversity of microbes that (in favourable conditions) work together to provide an acidic environment. For example, Lactobacilli bacteria secrete lactic acid which help to give the vagina its acidic pH level.
It is this acidic environment that helps to avoid an overgrowth of opportunistic microbes. When the unfriendly microbes outnumber the good, it is known as ‘dysbiosis’ and there are many factors that can contribute to an imbalance in women, including:
- a diet high in sugar and refined foods
- medications such as HRT or the contraceptive pill
- being overweight or obese
- synthetic chemicals
- hormonal imbalances
- sexual activity
- illness/immune dysfunction
Probiotics offer protection against urogenital pathogens
Due to the wide range of factors that can cause an imbalance, women can easily become vulnerable to yeast infections, bacterial vaginosis and other urogenital infections.
Vaginal yeast infections affect up to 3 out of 4 women at some point in their lifetimes and a significant 1.2 million women in the UK suffer from recurrent infections.1,2 Yeast infections are caused by an overgrowth of the fungus Candida albicans and symptoms include itching, irritation, and soreness.
Diet and lifestyle interventions are important and include supporting the immune system, minimising sugar intake, including natural sources of probiotics such as yoghurt (with live bacterial cultures), and supplementing with a good quality probiotic.
Certain Lactobacillus species have displayed antifungal activities that contribute to low Candida burdens3 and include Lactobacillus rhamnosus, Lactobacillus acidophilus and Lactobacillus heleveticus.4 A probiotic yeast such as Saccharomyces boulardii has also shown to be beneficial for yeast infections.5
Bacterial vaginosis (BV) is considered to be an overgrowth of anaerobic organisms combined with a loss of the protective lactobacilli normally found in a healthy vagina. It is the most common infection in women, affecting 15% to 50% of women of reproductive age1 but can affect all ages.
Many strains have been associated with beneficial BV outcomes – for instance, Lactobacillus rhamnosus is a natural resident of a healthy vaginal microbiome and has been extensively researched for its support of BV and other infections. Furthermore, there are a range of studies in support of probiotics and BV, and in recent systematic reviews and meta-analyses, it was concluded that probiotic regimes exhibited positive and beneficial effects for BV.2-4
Urinary Tract Infections
Urinary tract infections (UTIs) can affect the urinary tract, including bladder (cystitis), urethra (urethritis) or kidneys (kidney infection).1 Symptoms can include a burning sensation, a need to go to the toilet more often, high temperature, and pain in the lower stomach or back. It is estimated that annually, several hundred million women suffer from UTIs.2
Since lactobacilli dominate the urogenital flora in a healthy microbiome, it has been suggested that restoration of the urogenital flora with lactobacilli may protect against UTIs.3 In one meta-analysis, probiotic strains of Lactobacillus were shown to be safe and effective in preventing recurrent UTIs in adult women.4 One study in particular demonstrated the antagonist activity of Lactobacillus helevticus against uropathogenic pathogens.5
Probiotics and female gut health
An unbalanced microflora of the gastrointestinal (GI) tract may play a key role in the development of some GI symptoms and disorders, and women tend to be affected by digestive issues slightly more so than men.
For example, IBS has been reported to be a more common disease in women, with a female-to-male ratio of 2-2.5:1 in terms of those who seek medical care.1 Gut specific symptoms that may be indicative of an imbalance include constipation, gas, bloating, diarrhoea, heartburn and so on.
Studies show that probiotics can help to restore the natural balance of bacteria in the gut and maintain a healthy gastrointestinal tract.2 The key mechanisms of action include:
- Enhancement of the epithelial barrier
- Increased adhesion to intestinal mucosa
- Inhibition of pathogen adhesion
- Competitive exclusion of pathogenic microorganisms
- Modulation of the immune system
Further associations of probiotics and women’s health
The connection between our gut and immune health, reproductive health, mental wellbeing and many other aspects of health is well documented.
Stress, anxiety and depression
General anxiety affects over 100 million women worldwide and statistics show that women are twice as likely to be diagnosed with anxiety than men. Furthermore, there is now evidence of increasing anxiety and depression among young women.1,2 Stress is also common in the UK with 81% of women (compared to 67% of men) reporting at some point over the course of a year that they felt overwhelmed or unable to cope.4
The microbiota plays an important role in the bidirectional dialogue between the brain and the gut and thus probiotics may exert a beneficial effect on psychological problems such as stress and anxiety. Furthermore, stress can reshape the gut bacteria’s composition through stress hormones, inflammation, and autonomic alterations.3
Some probiotic strains have shown to be particularly beneficial for stress and anxiety.
For example, in one study, daily administration of Lactobacillus helveticus and Bifidobacterium longum showed a significant reduction of physiological symptoms associated with chronic stress and a further study with the same strains showed a reduction of anxiety and depression signs after thirty days.5,6
Additionally, in three recent systematic reviews and meta-analyses it was shown that probiotics improved and alleviated symptoms of depression and anxiety.7-9
Probiotics and their relation to fertility, pregnancy, the post-natal period
Fertility rates are lower than ever before with as many as 1 in 7 couples struggling to conceive.1 The bacteria living in our gut contribute to many essential processes, such as nutrient absorption, immune system regulation and hormone regulation, which at a very basic level can impact greatly on fertility.
Furthermore, the reproductive microbiome is now becoming recognised for its role in fertility, due to the increasing evidence that shows the impact of micro-organisms in the reproductive tract.2
We have already touched on some common infections that can occur in women above and these can also have negative consequences for fertility too. In one systematic review, the presence of pathogens in the genital tract affected fertility including asymptomatic BV.2
Infertility also often correlates with high levels of inflammation, and this can be seen in patients with endometriosis, polycystic ovary syndrome (PCOS) and other inflammatory conditions.3,4 A wide range of probiotic strains have demonstrated anti-inflammatory effects.
PCOS is among the most prevalent endocrine disorders in women.1 In one meta-analysis, synbiotics and probiotics in women with PCOS improved hormonal and inflammatory indices.1 Another review found that probiotic supplementation may improve glucose homeostasis parameters in women with PCOS.2
Gestational diabetes mellitus (GDM) is a condition in which women develop high blood sugar levels during pregnancy without having diabetes.1 One meta-analysis explored the efficacy of probiotic supplements in the treatment of GDM and found that interventions improved glucose metabolism and exerted anti-inflammatory and antioxidant ability.2
In a randomised controlled trial of 96 women receiving prophylactic antibiotic therapy after caesarean section delivery, it was shown that nearly 90% of patients receiving a probiotic supplement alongside antibiotic therapy were considered to have a balanced microbiome following therapy.
Conversely, in the control group, who weren’t administered probiotics, an imbalance in gut flora was observed.1 In a further study with the same strain (Lactobacillus helveticus), 103 pregnant women were given probiotics before and after a caesarean operation. The study showed a reduced opportunistic microflora (Candida albicans) with a preventative supplementation.2
Skin health and ageing – are probiotics beneficial?
There is some research that suggests that men’s skin may be less susceptible to the signs of ageing than women, although women are significantly more likely to say preventing the appearance of ageing skin is important.
The body of evidence demonstrating the beneficial effects of probiotics on the skin continues to grow in research due the connection between gut health and skin health and several mechanisms of action have been proposed such as:1
- restoring acidic skin pH
- alleviating oxidative stress
- attenuating photoaging
- improving skin barrier function
Furthermore, cellular senescence is an intrinsic ageing process that has been recently associated with microbial imbalance.2 In one study, Lactobacillus plantarum improved skin hydration and had anti-photoaging effects.3
Osteoporosis: exciting new research demonstrates a potential role probiotics may play in modulating bone health
In England and Wales, more than 2 million women have osteoporosis.1 Postmenopausal osteoporosis is characterized by low bone mass and structural deterioration of bone tissue with increased risk of fracture in postmenopausal women. It is due to a deficiency of oestrogen production after the menopause.2
Emerging research has demonstrated the potential of the intestinal microbiota (and subsequently probiotics) to modulate bone health. One way this occurs is through the regulation of mineral absorption which is required for healthy bone. In addition, endocrine factors that influence the absorption of these minerals as well as gut-derived factors such as incretins and serotonin can also influence bone turnover.3
In one meta-analysis of randomised controlled trials it was suggested that strains including Lactobacillus casei could increase lumbar bone mineral density in postmenopausal women.4
Considerations: choosing the right probiotic
There are many things to consider when deciding which probiotic is right for you. These include:
- the number of colony forming units (CFUs) – higher CFUs don’t necessarily mean it is a better product and may not improve the product’s health effects. Equally, high amounts of CFUs may not be suitable for children, the elderly or if there is a high degree of sensitivity
- types of bacterial strains – it is also important to consider the types of strains present and the efficacy of the strains shown in studies. Each individual strain should have been researched for its unique benefits, which should fit with your health goals
- the combination of strains is also important as compatibility between the strains is key to prevent one strain from competing negatively with the other. The more complementary strains present, the greater the beneficial sphere of activity
- prebiotics – does it contain a prebiotic to support the probiotic strains within the product
- validation – have the strains been clinically validated in human trials
- being able to survive the journey through the gastrointestinal tract – does it have an effective delivery system or time-controlled release, for instance
- stability through its shelf-life
- Women in general have slightly different needs and may require additional support relating to vaginal, digestive, hormonal and urogenital imbalances
- Lactobacilli bacteria secrete lactic acid which help to give the vagina its acidic pH level
- Certain Lactobacillusspecies have displayed antifungal activities that contribute to low Candida burdens
- There are a range of studies in support of probiotics and bacterial vaginosis
- It has been suggested that restoration of the urogenital flora with lactobacilli may protect against UTIs
- Studies show that probiotics can help to restore the natural balance of bacteriain the gut and maintain a healthy gastrointestinal tract
- Some probiotic strains have shown to be particularly beneficial for stress and anxiety
- The reproductive microbiome is now becoming recognised for its role in fertility
- Probiotic supplementation may improve glucose homeostasis parameters in women with PCOS
- Cellular senescence is an intrinsic ageing process that has been recently associated with microbial imbalance
- Emerging research has demonstrated the potential of the intestinal microbiota (and subsequently probiotics) to modulate bone health
Probiotics for women references:
- Yeast infection (vaginal) – Symptoms and causes – Mayo Clinic (2022). (Accessed: August 22, 2022).
- New figures show 138 million women suffer from recurrent thrush (2018). (Accessed: August 22, 2022).
- Alonso-Roman, R. et al. (2022) “Lactobacillus rhamnosus colonisation antagonizes Candida albicans by forcing metabolic adaptations that compromise pathogenicity,” Nature Communications 2022 13:1, 13(1), pp. 1–15.
- Vazquez-Munoz, R. and Dongari-Bagtzoglou, A. (2021) “Anticandidal Activities by Lactobacillus Species: An Update on Mechanisms of Action,” Frontiers in Oral Health, 0, p. 47.
- Kunyeit, L., Anu-Appaiah, K.A. and Rao, R.P. (2020) ‘Application of probiotic yeasts on candida species associated infection’, Journal of Fungi, 6(4), pp. 1–12.
- Cohen, C.R. et al. (2020) ‘Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosis’, New England Journal of Medicine, 382(20), pp. 1906–1915.
- Tidbury, F.D. et al. (2021) “Non-antibiotic treatment of bacterial vaginosis-a systematic review,” 303, pp. 37–45.
- Wang, Z., He, Y. and Zheng, Y. (2019) “Probiotics for the Treatment of Bacterial Vaginosis: A Meta-Analysis,” International journal of environmental research and public health, 16(20).
- Chen, R. et al. (2022) “Probiotics are a good choice for the treatment of bacterial vaginosis: a meta-analysis of randomized controlled trial,” Reproductive health, 19(1).
Urinary Tract Infections
- Urinary tract infections (UTIs) – NHS (2022). Available at: https://www.nhs.uk/conditions/urinary-tract-infections-utis/ (Accessed: 1 September 2022).
- Reid, G. and Bruce, A.W. (2003) ‘Urogenital infections in women: can probiotics help?’, Postgraduate medical journal, 79(934), pp. 428–432.
- Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies | Request PDF (2021). (Accessed: 1 September 2022).
- Grin, P.M. et al. (2013) ‘Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis’, The Canadian journal of urology, 20(1), pp. 6607–6614.
- Taverniti, V. and Guglielmetti, S. (2012) “Health-Promoting Properties of Lactobacillus helveticus,” Frontiers in Microbiology, 3(NOV).
- Kim, Y.S. and Kim, N. (2018) ‘Sex-Gender Differences in Irritable Bowel Syndrome’, Journal of Neurogastroenterology and Motility, 24(4), p. 544.
- Hemarajata, P. and Versalovic, J. (2013) ‘Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation’, Therapeutic advances in gastroenterology, 6(1), pp. 39–51.
Stress and anxiety
- Young people’s well-being in the UK – Office for National Statistics (2020). (Accessed: August 19, 2022).
- Remes, O. et al. (2016) “A systematic review of reviews on the prevalence of anxiety disorders in adult populations,” Brain and Behavior, 6(7), p. e00497.
- Madison, A. and Kiecolt-Glaser, J.K. (2019) “Stress, depression, diet, and the gut microbiota: human–bacteria interactions at the core of psychoneuroimmunology and nutrition,” Current opinion in behavioral sciences, 28, p. 105. doi:10.1016/J.COBEHA.2019.01.011.
- Stressed nation: 74% of UK ‘overwhelmed or unable to cope’ at some point in the past year | Mental Health Foundation (2018). (Accessed: 2 September 2022).
- Diop, L., Guillou, S. and Durand, H. (2008) “Probiotic food supplement reduces stress-induced gastrointestinal symptoms in volunteers: a double-blind, placebo-controlled, randomized trial,” Nutrition Research, 28(1), pp. 1–5.
- Messaoudi, M. et al. (2011) “Beneficial psychological effects of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in healthy human volunteers,” Gut microbes, 2(4).
- Nikolova, V.L. et al. (2021) “Perturbations in Gut Microbiota Composition in Psychiatric Disorders: A Review and Meta-analysis,” JAMA psychiatry, 78(12), pp. 1343–1354.
- el Dib, R. et al. (2021) “Probiotics for the treatment of depression and anxiety: A systematic review and meta-analysis of randomized controlled trials,” Clinical nutrition ESPEN, 45, pp. 75–90.
- Minayo, M. de S., Miranda, I. and Telhado, R.S. (2021) “A systematic review of the effects of probiotics on depression and anxiety: an alternative therapy?,” Ciencia & saude coletiva, 26(9), pp. 4087–4099.
- Infertility – NHS (2022). (Accessed: 2 September 2022).
- Vitale, S.G. et al. (2021) ‘The Role of Genital Tract Microbiome in Fertility: A Systematic Review’, International journal of molecular sciences, 23(1).
- Abraham Gnanadass, S., Divakar Prabhu, Y. and Valsala Gopalakrishnan, A. (2021) ‘Association of metabolic and inflammatory markers with polycystic ovarian syndrome (PCOS): an update’, Archives of gynecology and obstetrics, 303(3), pp. 631–643.
- Malvezzi, H. et al. (2019) ‘Interleukin in endometriosis-associated infertility-pelvic pain: systematic review and meta-analysis’, Reproduction (Cambridge, England), 158(1), pp. 1–12.
- Shamasbi, S.G., Ghanbari-Homayi, S. and Mirghafourvand, M. (2020) ‘The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis’, European journal of nutrition, 59(2), pp. 433–450.
- Hadi, A. et al. (2020) ‘Effect of probiotics and synbiotics on selected anthropometric and biochemical measures in women with polycystic ovary syndrome: a systematic review and meta-analysis’, European journal of clinical nutrition, 74(4), pp. 543–547.
- Peng, T.R., Wu, T.W. and Chao, Y.C. (2018) ‘Effect of Probiotics on the Glucose Levels of Pregnant Women: A Meta-Analysis of Randomized Controlled Trials’, Medicina (Kaunas, Lithuania), 54(5), pp. 1–14.
- Zhou, L. et al. (2021) “Probiotics and synbiotics show clinical efficacy in treating gestational diabetes mellitus: A meta-analysis,” Primary care diabetes, 15(6), pp. 937–947
- Sharma, D., Kober, M.M. and Bowe, W.P. (2016) ‘Anti-Aging Effects of Probiotics’, Journal of drugs in dermatology : JDD, 15(1), pp. 9–12.
- Boyajian, J.L. et al. (2021) ‘Microbiome and Human Aging: Probiotic and Prebiotic Potentials in Longevity, Skin Health and Cellular Senescence’, Nutrients, 13(12).
- Lee, D.E. et al. (2015) ‘Clinical Evidence of Effects of Lactobacillus plantarum HY7714 on Skin Aging: A Randomized, Double Blind, Placebo-Controlled Study’, Journal of microbiology and biotechnology, 25(12), pp. 2160–2168.
- Prevalence | Background information | Osteoporosis – prevention of fragility fractures | CKS | NICE (2022). (Accessed: 6 October 2022).
- Huidrom, S., Beg, M.A. and Masood, T. (2020) ‘Post-menopausal Osteoporosis and Probiotics’, Current Drug Targets, 22(7), pp. 816–822.
- Collins, F.L. et al. (2017) ‘The Potential of Probiotics as a Therapy for Osteoporosis’, Microbiology spectrum, 5(4).
- Yu, Jiawei et al. (2021) ‘Probiotic supplements and bone health in postmenopausal women: a meta-analysis of randomised controlled trials’, BMJ Open, 11(3), p. e041393.
If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.
Last updated on 23rd November 2022 by cytoffice