The fix for bloating in your 50s? Meet the ‘other’ microbiome (it’s in your pants)

For the last few years, when we think about our microbiome, the gut has taken centre stage and rightly so. But there’s another, often overlooked ecosystem that deserves just as much attention, especially for women over 50 – the vaginal microbiome.

Just like the gut, the vagina is home to a complex community of microbes that play a vital role in keeping everything in balance. And as we move through perimenopause and menopause, this delicate system becomes far more vulnerable to disruption. The key is knowing how to support it.

Why the vaginal microbiome changes after 50

As oestrogen levels decline during perimenopause, we see significant shifts not only in the gut microbiome but also in the vaginal environment. Take oestrogen, which helps maintain the dominance of beneficial bacteria, particularly Lactobacillus species, in the vagina. These bacteria produce lactic acid, which keeps vaginal pH low and helps protect against infections such as thrush and bacterial vaginosis. As oestrogen levels drop during menopause, this protective system weakens, which can create a less acidic environment, reduced levels of beneficial bacteria, and a greater susceptibility to imbalances and infections. Many women find they struggle with thrush, for example.

At the same time, research shows that postmenopausal women tend to have lower gut microbiome diversity compared to premenopausal women, a shift driven by hormonal changes rather than ageing alone. This matters because these two microbiomes don’t operate in isolation.

The gut–vagina axis: a two-way relationship

Emerging science highlights a fascinating connection known as the gut–vagina axis. In simple terms, the health of your gut microbiome can influence your vaginal microbiome, and vice versa.

One key player here is the estrobolome, a collection of gut bacteria involved in oestrogen metabolism. These microbes help regulate circulating oestrogen levels by reactivating and recycling the hormone within the body. When the gut microbiome is diverse and well-nourished, this system works more efficiently. But when diversity drops (something we commonly see during perimenopause and beyond), this can impact hormone balance and, indirectly, vaginal health. This interconnectedness helps explain why some women experience both digestive symptoms (such as bloating and constipation) and vaginal imbalances during midlife.

Everyday habits that can disrupt vaginal balance

While hormonal changes set the stage, some everyday habits can further disrupt the vaginal microbiome. These include:

• Overuse of intimate washes or douching, which can strip away protective bacteria
• Frequent antibiotic use, which affects both gut and vaginal microbes
• Highly restrictive diets that limit fibre and plant diversity
• Chronic stress and poor sleep, both of which can influence microbial balance
• Tight, non-breathable clothing that creates a less favourable environment

The problem with restrictive diets

To help counteract the effects of recurrent issues such as thrush, you may have come across the candida diet, a highly restrictive approach that eliminates sugar, many carbs, and even entire food groups in an attempt to ‘starve’ yeast. It’s a compelling idea, but the science simply doesn’t support it.

Candida (a type of yeast) naturally exists in the body, and overgrowth isn’t driven by (or managed through) sugar intake alone. More importantly, restrictive diets can actually harm your gut microbiome by reducing the diversity of fibres and plant compounds it relies on. Since a less diverse gut microbiome may negatively affect vaginal health, cutting out foods in the name of ‘balance’ can sometimes backfire – this is something I see often in clinic.

A balanced diet is a key factor in keeping vaginal and gut microbiomes healthy.

Can probiotics help?

Probiotics are also often marketed as a quick fix, but the reality is more nuanced. Despite the clever marketing, research shows that one-size-fits-all probiotic supplements often don’t deliver noticeable benefits. That’s because different strains have very different effects in the body.

But when it comes to vaginal health, specific strains show impressive results. For example, Lactobacillus acidophilus La-14 and Lactobacillus rhamnosus HN001, when combined with lactoferrin, have been shown in clinical trials to reduce symptoms and recurrence of issues like thrush and bacterial vaginosis, by up to three times compared to placebo. So rather than taking a scattergun approach, it’s about choosing the right strain, at the right time, in the right way, as proven by the human clinical trials.

The most powerful tool? Your diet

While supplements can play a role, diet is still the foundation of microbiome health, both in the gut and beyond. Here’s what the science supports:

1. Prioritise fibre. Aim for at least 30g a day from what I call the Super Six – vegetables, fruits, wholegrains, legumes, nuts and seeds, plus herbs and spices. These fibres are fermented by gut microbes to produce short-chain fatty acids, which support gut barrier function and reduce inflammation.

2. Maximise plant diversity. Different plants feed different microbes. Increasing the variety of plant foods in your diet helps build a more resilient microbiome, which may, in turn, support vaginal health via the gut-vagina axis.

3. Include fermented foods. Foods such as yogurt, kefir, sauerkraut and kimchi provide live microbes and beneficial compounds that can support microbial balance and diversity.

4. Add oily fish. Rich in omega-3 fatty acids, oily fish may help support the estrobolome and play a role in hormone regulation.

5. Don’t overlook soy and legumes. These contain phytoestrogens (plant compounds with mild oestrogen-like effects), which have been linked to improvements in menopause-related symptoms. Interestingly, one study found that women who regularly consumed legumes and oily fish reached menopause up to four years later than those who rarely ate them, highlighting just how powerful diet can be.

Known as The Gut Health Doctor, Dr Megan Rossi is a gut health scientist, bestselling author and founder of SMART STRAINS.