Mary is a freelance nurse writer specializing in making healthcare and medical content accessible for people at all levels of health literacy. Her MSN in nursing education prepared her to deliver accurate and trustworthy medical information that educates and empowers the public.

Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.

Bacterial vaginosis (BV) is an infection from an overgrowth of vaginal bacteria. Your vagina always has a basic amount of bacteria (called flora) that is healthy and natural. The increase of less common bacteria upsets the natural balance of the vagina and can cause uncomfortable symptoms.

BV is prevalent among women and has been identified as the most common cause of abnormal vaginal discharge. A study found that 23%–29% of women experience BV.

Risk factors for BV include having multiple sex partners, douching, pregnancy, and smoking. BV risk can increase around menopause for women due to hormonal changes.

This article discusses bacterial vaginosis in menopause and its causes and risk factors.

Bacterial vaginosis is very common among women from puberty to menopause. During menopause, women undergo changes in their hormone levels. BV can appear for the first time or return as your childbearing years end.

About 1 in 4 women in the United States will experience BV, which is much more common in Black and Hispanic women than in White and Asian women. The risk of BV increases with age and with previous BV diagnoses.

Beneficial vaginal bacteria thrive in environments with estrogen. As estrogen levels drop in menopause, good bacteria levels can also decrease, which increases the risk of developing BV. Overall, your risk for BV appears to increase as you age.

Many attempts have been made to understand what causes harmful bacteria to overtake the normal flora. The cause of BV remains unknown.

The bacteria that cause BV can vary widely. One theory is that the environment of the vagina changes to allow the overgrowth that causes BV. Individual immune systems factor into it too.

Some risk factors for BV include:

Along with menopause, both intrauterine device (IUD) use and pregnancy can also increase your chances of developing BV. As well, female sexual partners sometimes share BV back and forth.

There are no proven methods to prevent BV. However, some of the factors that increase your chance of getting BV are ones in your control. Some things that may help lower your risk for BV include:

For women who are entering perimenopause, research suggests that there may be some additional ways you can prevent BV. Probiotics may be helpful in some cases. However, these are not right for every person, so check with your healthcare provider before starting any medications or supplements.

If you develop BV, be sure to see your healthcare provider. Untreated, BV can cause severe complications, such as increasing your risk of sexually transmitted infections (STIs) or problems with your pregnancy.

Many women with BV have no symptoms at all, but you can have one or many symptoms. Common symptoms include:

The symptoms of BV might be similar to other medical issues, including yeast infections, which are caused by fungi. If you have any symptoms, see your medical provider for a diagnosis and proper treatment.

BV can only be diagnosed by a healthcare provider. Typically, your provider will collect a sample from your vagina using a swab and send it to the lab. Depending on the results of the tests, you may be diagnosed with BV.

Sometimes, the lab will culture the vaginal fluid to see what bacteria are growing there.

BV is highly treatable. Approximately 80%–90% of BV cases are cured within one month. However, more than half of those may return within the first year. Treatment for male sex partners of women with BV is not recommended.

In the United States, treatment is recommended only for people with symptoms of BV. Antibiotics are a common BV treatment. These medications kill off the harmful bacteria and help to restore the balance of bacteria in the vagina. Flagyl (metronidazole) or Cleocin (clindamycin) are often used.

Bacterial vaginosis is a common health condition that can happen to women at any age. Sometimes, BV can start or worsen during the hormonal changes leading to menopause. You can adjust a few risk factors to reduce your risk of developing BV. In many cases, BV is highly treatable with medications. See your healthcare provider for a diagnosis if you notice any unusual vaginal discharge or other symptoms.

Vaginal discharge and odor can be sensitive and concerning issues. Medical professionals are trained to listen to and address your concerns with compassion and privacy. Do not hesitate to let your provider know if you have symptoms of BV or similar health issues. Treatment is effective and important in maintaining your overall health.

Estrogen helps keep the environment optimized for good vaginal bacteria. Low estrogen can increase the risk of developing BV.

Some healthcare providers recommend probiotics to help reduce the risk of BV after menopause. Check with your healthcare team about your specific health situation.

The exact cause of BV is unknown. However, there are several factors that can increase your chances of developing BV.

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