As you likely know, female physiology is more complicated than male physiology. After all, women have to contend with ovulation and menstrual cycles, gestation and child birth, changes in hormonal levels through menarche and menopausal years, changes in vaginal and urinary health with aging, among other phenomena. Accompanying these changes in female physiology over the years are also changes and disruptions of the microbiome, gastrointestinal and otherwise.

Let’s put aside the common microbial factors that men and women share, such as the need for microbial diversity, keystone species, and fibers to nourish microbes, needs shared by everyone. Let’s instead focus on some of the microbial situations that are now known to play unique and outsized roles in female health:

  • Lactobacillus reuteri—Among my favorite microbes, L. reuteri plays an important role in female reproductive and vaginal health. L. reuteri provokes release of oxytocin that facilitates the delivery of a child by causing uterine contraction, as well as lactation and maintenance of postpartum childrearing behaviors. Lack of L. reuteri and oxytocin can impair uterine contraction during delivery, impair expression of breastmilk for breastfeeding, and cause postpartum depression.  L. reuteri also plays a crucial role in maintaining a healthy, moist vaginal lining. As women age, especially after age 65, dryness, irritation, discharge, and pain with penetration (dyspareunia) become increasingly common. Restoration of this microbial species, also via oxytocin, can play a major role in restoring youthful moisture and vaginal lining. L. reuteri and oxytocin also play an important role in maintaining libido, i.e., interest in sexual activity. Recall from my many discussions about L. reuteri that nearly everyone has lost this microbe due to its susceptibility to common antibiotics.
  • Lactobacillus crispatus—This microbe is the dominant bacterial species in a healthy vaginal microbiome. Without it, unhealthy species proliferate, species such as Atopobium, Gardnerella, and fecal microbes such as E. coli, a situation labeled “vaginosis” or vaginal dysbiosis. Remarkably, it is estimated that around 30% of the world’s female population has vaginosis. This has serious real world implications that include increased risk for miscarriages and premature delivery of a child, since undesirable microbes in the vagina can trigger premature relaxation of the cerivix. Lack of L. crispatus can also increase risk for vaginal infections from fecal microbes and yeasts like Candida albicans, and cause irritation and discharge. L. crispatus also protects a woman from urinary tract infections, a plague for many women who resort to repeated courses of antibiotics that, over time, severely erode overall health. Not only does this species colonize the vagina, but it also—to the shock of many of us who thought the urinary bladder was sterile—colonizes the bladder, thereby protecting the bladder from infection from fecal microbes.
  • Lactobacillus gasseri—Like L. reuteri, L. gasseri is a “keystone” species, i.e., an essential species that supports overall microbiome composition, “encouraging” other beneficial microbes while suppressing unhealthy, mostly fecal, species. It is also susceptible to common antibiotics and other factors such as glyphosate, reducing or eradicating this microbe from the GI microbiomes of most females. L. gasseri (CP2305) plays an important role in minimizing the unpleasant phenomena of menopause, including psychological symptoms such as irritability, depression, insomnia, and dizziness, as well as vasomotor symptoms such as hot flashes, chills, and excessive sweating.
  • β-glucuronidase activity—Numerous species of bowel flora express an enzyme that metabolizes estrogens in the gut, leading to reabsorption into the circulation, thereby increasing estrogen blood levels that have been associated with increased breast cancer risk. Among the most important species participating in this process: E. coli, the microbe that commonly overgrows in women with colonic dysbiosis and small intestinal bacterial overgrowth, SIBO, also the microbe responsible for 80% of urinary tract infections.

Neglect of the above issues relevant to female health and you can be left with less rewarding relationships, not enjoying the intensity of love and affection afforded by full expression of oxytocin. You will experience vaginal dryness with aging, maybe resorting to estrogen preparations instead that increase risk for endometrial cancer and thromboembolic disease (blood clots). You may experience repeated urinary tract infections, prompting antibiotic prescriptions by your doctor who is unaware of the role of the vaginal microbiome. You may suffer through the hot flashes, mood swings, sleep disruption, and depression of menopausal years, receiving prescriptions for estrogens, antidepressants, and anti-anxiety medication. And you may have to deal with the emotional and physical trauma of a breast cancer diagnosis. In short, it is unwise to ignore the contribution of the microbiome to female health. Drugs are not the solution. The solution is to address the underlying microbial factors that drive or exacerbate such phenomena.

If all of this is new to you, I invite you to get up-to-speed by reading my Super Gut book, a prescriptive discussion on how to accomplish much of the above. Also, see the many discussions here in this blog, as well as the many two-way Zoom discussions and protocols that we have in my Inner Circle website.