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Probiotics: Should You Take Them for Your Gut?

How about for your vagina?

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illustration of probiotic pills forming shape of uterus
Seb Agresti
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Wander the health aisles of your supermarket or drugstore and you’ll see shelves packed with probiotic supplements claiming to contain the so-called “good” bacteria that research suggests may benefit our gut and immune system. Sales of these products have become a multibillion-dollar global industry, including the latest addition: vaginal pills and suppositories aimed at women hoping to ward off vaginal infections or help with postmenopausal changes by seeding their vaginas with helpful bacteria.

But do probiotic supplements for the vagina — or the gut — really boost our health? Or is this more hype than help?

Consider those gut probiotic pills: In healthy people, research suggests, eating more fruits and vegetables may be a better way to improve the gut microbiome than taking probiotic pills that studies show offer little benefit. For those with health conditions, be aware that recent studies show that over-the-counter probiotics can affect different people in markedly different ways.

A 2023 Stanford study published in the journal Gut Microbes found that of the 39 study participants, some adults at high risk for type 2 diabetes saw an improvement in their blood pressure and triglyceride levels with probiotics, while others experienced a worsening in their blood sugar and insulin levels. "These data suggest that response to probiotic supplements in metabolic syndrome may be diet dependent," the authors said. And a preliminary study in 2019 by researchers at MD Anderson Cancer Center and the Parker Institute for Cancer Immunotherapy found that taking over-the-counter probiotics significantly interfered with cancer immunotherapy for a group of skin cancer patients.

Bottom line: Don’t assume probiotics will help; talk to your doctor before taking them.

In my case, I hadn’t even thought about taking vaginal probiotics until my gynecologist urged me to consider it, saying “some studies” showed it might be helpful. The loss of estrogen after menopause, she told me, can upset the balance of helpful and unhelpful bacteria in the vagina, which can then raise the risk for infection and might contribute to postmenopausal issues like vaginal dryness and urinary tract infections.
 
But standing in front of a shelf of vaginal probiotic products later that day, I hesitated. The claims seemed either vague (“helps promote vaginal health”) or unsettling (“contains yeast-digesting enzyme blend”). And knowing that the U.S. Food and Drug Administration doesn’t test or approve any of these products before they hit the market certainly didn’t add to my confidence.

The fact is, we still don’t know exactly which probiotics are helpful and which are not. The scientific evidence for adding live microorganisms to reset the vagina is inconclusive, at best, and many women’s health experts remain highly skeptical about the supposed benefits from these products. There are also questions about the ingredients: Some vaginal probiotics contain strains of bacteria that are more common in the gut than the vagina. Others have been reported to contain microorganisms other than what is listed on the label.

Gynecologist Jen Gunter, a specialist in vaginal disorders and author of The Vagina Bible, is well-known on social media (@drjengunter) for her blunt opinions about things you should not put in your vagina, including probiotics. She put it this way on Instagram last year: “Probiotics for the vaginal microbiome are untested scams. There is zero data that what you buy over the counter can help you in [any way].”

Stephanie Faubion, M.D., director of the Mayo Clinic Center for Women’s Health and medical director of the North American Menopause Society, also criticized the lack of science behind these products. “There’s no evidence that these products will do what they say, or that any vaginal change they cause will actually help,” she said in an interview.

The majority of vaginal probiotic products on the market are oral capsules and Faubion questioned how swallowing a pill that goes through the stomach and the intestines is going to be able to get helpful bacteria into the vagina. “It doesn’t make sense to me,” she said. Other researchers wondered the same thing and wrote in the Journal of Genetics and Genomics that a 2021 study of 60 women who took probiotic pills for more than a year “revealed a very limited ability of the probiotics to reach the vagina."

Suppositories inserted in the vagina may not be much better. A 2019 review, published in the British Journal of Obstetrics and Gynecology, that analyzed studies of 22 vaginal probiotic suppositories, found that the probiotics hung around the vaginal biome only as long as women kept taking them — suggesting that the probiotic strains didn’t take root in the vagina and couldn’t be counted on for long-term benefits.

“Taking a probiotic alone is not beneficial for postmenopausal vaginal health,” and is unlikely to help with symptoms like vaginal dryness or pain during sex, said Caroline Mitchell, M.D., director of the vulvovaginal disorders program at Massachusetts General Hospital and associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

Based on research by her team and others, the use of low-dose vaginal estrogen preparations — like creams, a tablet or a ring — is associated with a shift in the microbiome toward more healthy and protective strains of Lactobacillus. “This kind of estrogen has minimal systemic absorption and thus is very safe for most people — including breast cancer survivors,” Mitchell said.

She also recommends to her patients the following non-estrogen products to reduce vaginal symptoms, adding that it’s important to get checked to be sure there isn’t a yeast infection, skin condition or something other than menopause that’s causing vaginal pain or irritation.

• Vaginal moisturizers, including newer formulations with hyaluronic acid, and/or lubricants to help with discomfort during sex.

• Non-estrogen-based hormonal products, including a vaginal suppository with DHEA, which is converted into estrogen inside cells, so it has a lower hormone exposure, or an oral SERM (selective estrogen receptor modulator) that was approved to treat postmenopausal pain with sex.

As for me, I decided to take my gynecologist’s suggestion and give vaginal probiotic pills a try. I took them daily, as the label directed, for more than a month. Frankly, the only thing they seemed to do for me was give me a bad case of heartburn.

 
Do any of you take probiotics? Let us know in the comments below.

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