Estrogen is very important for vaginal health, therefore, vaginal complaints, especially discharge, can be an important problem in the menopausal period when estrogen decreases. Cells forming the vaginal walls produce glycogen in the presence of estrogen, and glycogen is the energy source for bacteria called Lactobacillus. Lactobacilli create an acidic environment in the vagina, preventing the growth of pathological microorganisms and creating natural protection. It creates a balance between disease-causing and non-disease bacteria. After menopause, there is a decrease in the levels of the hormone estrogen, and therefore the cells that make up the walls of the vagina decrease and become thinner. This condition is called vaginal atrophy. In vaginal atrophy, glycogen production decreases, so the number of Lactobacilli decreases and acidity decreases. This can cause other bacteria to increase and form a discharge.
Vaginal discharge is usually normal, but some characteristics of the discharge, such as color and odor, may indicate the presence of an infection or other condition. Physiological vaginal discharge is typically white or clear. The amount of vaginal discharge is 1-4 ml in 24 hours. Healthy vaginal discharge does not have a foul odor.
In menopause, discharges caused by the increase of other bacteria in the vaginal flora, which we call bacterial vaginosis due to the deterioration of the bacterial balance in the vagina, and vaginal candidiasis caused by fungi are seen. Less frequently, infections caused by sexually transmitted bacteria can also occur.
Among these three important causes, bacterial vaginosis is the most common (40-50%), followed by vaginal candidiasis (20-25%) and trichomoniasis (15-20%), a parasitic disease. In bacterial vaginosis, a foul-smelling (rotten fish smell), white, creamy discharge is observed. In the fungus, a white discharge like a milk cut is seen with itching. A green, foul-smelling discharge is more suggestive of trichomoniasis. When examined with a speculum, the cause of the discharge is usually clear. In addition, pH test, evaluation of bacteria on wet glass with a microscope or vaginal culture tests can be done.
Treatment of these infections is antibiotics and local vaginal estrogen. Antibiotics are prescribed for the pathogen causing the discharge. Estrogen hormone increases the Lactobacilli in the vagina and thus reduces other pathogens. In addition, the use of microorganisms that benefit the host organism, which we call probiotics, can be considered in recurrent infections. The use of probiotics alone or in combination with antibiotics positively changes the vaginal flora and can reduce vaginal infections in postmenopausal women.
Vaginal atrophy can sometimes cause vaginal discharge due to irritation of the vagina, especially after sexual contact or using products such as hygiene sprays, perfumes, laundry soaps, bleaches, fabric softeners, and latex condoms for women who are allergic to latex. In these cases, removing the cause of irritation and using water-based lubricants during sexual intercourse will reduce the discharge.
Vaginal estrogen reduces both the likelihood of re-infection by bacterial pathogens and the possibility of irritation of the vagina due to atrophy. It can be used for prophylaxis.
