The Vaginal Microbiome: What Testing Reveals and Who Should Know About It

Most women don’t know their vaginal microbiome can be tested. Once they find out, the question is usually: why hasn’t anyone offered me this?

It’s a reasonable question. The vaginal microbiome has clinical relevance across several life stages, and for women dealing with recurrent infections, preparing for pregnancy, or navigating the hormonal shifts of perimenopause and menopause, this testing can be genuinely clarifying.

What a Healthy Vaginal Microbiome Looks Like

A healthy vaginal microbiome is dominated by Lactobacillus species, primarily L. crispatus or L. iners. These bacteria maintain an acidic pH that protects against opportunistic pathogens and supports overall vaginal health.

When Lactobacillus dominance is disrupted, the ecosystem becomes more hospitable to bacteria associated with bacterial vaginosis, as well as yeast overgrowth and other organisms linked to recurrent infections. This disruption is known as vaginal dysbiosis, and when tested, it can be addressed.

During Pregnancy: GBS and Birth Canal Health

Group B Streptococcus colonization is screened for at 35-37 weeks. A positive result leads to antibiotics during labor. For women who want to be proactive about this, vaginal microbiome testing during pregnancy gives us information about the ecosystem your baby will move through at birth.

A Lactobacillus-dominant vaginal environment is associated with lower GBS colonization rates. Supporting that balance during pregnancy is an evidence-informed strategy for women who’ve had previous GBS positivity or who are thinking carefully about their baby’s microbial inheritance.

Perimenopause and Menopause: An Often-Overlooked Shift

As estrogen declines in perimenopause and menopause, the vaginal microbiome shifts. Lactobacillus species depend on estrogen to maintain their dominance, as estrogen falls, that dominance diminishes. Vaginal pH rises. Susceptibility to infection increases. The tissue changes associated with genitourinary syndrome of menopause (dryness, discomfort, recurrent infections) have a microbial component alongside the hormonal one.

This is an area where testing is useful because it separates out what’s purely hormonal from what’s also microbial — and the interventions differ depending on what you find. Some women benefit primarily from hormonal support; others have a dysbiosis pattern that needs direct attention alongside or before hormonal approaches.

What Testing and Treatment Look Like

Vaginal microbiome testing is done at home with a simple swab kit. Results give us a species-level picture of the vaginal ecosystem. I interpret these results alongside a full clinical picture: hormonal status, gut microbiome findings, symptoms, and history.

Treatment is specific to results. Targeted Lactobacillus strains, boric acid where appropriate, dietary and lifestyle support, and coordination with hormonal management where relevant.

If you’ve been dealing with recurrent vaginal infections, if you’re preparing for pregnancy, or if you’re in perimenopause and noticing changes you haven’t been able to resolve, this is worth looking at. Book a consultation or explore the testing we use.