Why Older Women Can Still Get Bacterial Vaginosis
I’ll be honest—I never expected to deal with something like bacterial vaginosis in my 50s. Like many women, I assumed it was something younger folks had to think about. Turns out, I was wrong. A subtle change in how things felt and a persistent, slightly off smell prompted a conversation with my doctor. That’s when I first heard: “Yes, older women can absolutely get BV.” And I’ve since realized I wasn’t alone.
Understanding BV: It’s Not Just a Young Woman’s Condition
Let’s clear up a common myth: BV isn’t an STI, and it doesn’t discriminate based on age. The condition stems from an imbalance in vaginal bacteria—too much of the “bad” kind (mostly anaerobic bacteria) and not enough of the “good” kind like lactobacilli.
So, why does it happen more often than we think in older women? As estrogen levels dip (particularly during and after menopause), the vaginal environment changes. Less estrogen means thinner vaginal walls and reduced glycogen, which affects the pH and overall bacterial balance. Basically, Mother Nature messes with your microbiome.
Hormonal Shifts and Vaginal Changes in Aging
Estrogen’s Role in Vaginal Health
Estrogen keeps the vaginal tissue thick, elastic, and full of good bacteria. When it decreases:
- The pH rises, making it more alkaline
- Lactobacilli decrease
- Opportunistic bacteria thrive
This shift creates the perfect setup for BV. It also explains why many postmenopausal women start noticing unusual discharge or mild odor, which they might attribute to “just getting older.”
Other Age-Related Contributors
- Increased frequency of recurrent BV episodes
- Vaginal dryness leading to microtears
- Weakened immune response
Common Signs BV Might Be Lurking (Even If It’s Not Obvious)
For older women, the symptoms might be even more subtle:
- Persistent or mild fishy vaginal odor
- Thin, grayish-white discharge (may not always be noticeable)
- Itching or slight burning, especially during urination
- Feeling like “something’s off” even without pain
Don’t dismiss these as “just aging.” BV can persist quietly but still create a higher risk for vaginal infections and discomfort. It’s even been linked to fertility issues in some cases, though that’s more relevant pre-menopause.
BV Isn’t Always About Sex
I asked my doctor straight up—“But I haven’t even been sexually active recently. Why now?” She explained that sexual activity is just one of many risk factors. For older women, it’s often not about sex at all. Instead, it could be:
- Hygiene habits: Over-washing, douching, or using scented products (which can mess with pH)
- Stress and health issues: Chronic illnesses, stress, or even antibiotic use
- Hormonal meds: Like HRT (Hormone Replacement Therapy), which may help or hinder depending on the formulation
Even tight clothing or synthetic underwear can contribute. That’s why I switched to breathable cotton options after reading about underwear choices and BV. Small change, big difference.
Diagnosing BV in Older Women: Don’t Guess
It’s surprisingly common for BV to be misdiagnosed as a yeast infection, especially in older women. If you’ve tried OTC antifungals with no relief, that’s a red flag. Your best bet is to:
- Schedule a vaginal exam
- Request a pH test (BV usually >4.5)
- Consider a lab test to rule out STIs or trichomoniasis
Self-diagnosis is tempting, but it’s a gamble. I personally wasted two weeks treating “a yeast thing” with OTC meds before realizing it was BV. When I finally got the right treatment, the difference was night and day.
Where to Learn More and What to Do Next
If you’re still unsure whether what you’re experiencing is BV, or if you want to know more about treating it naturally or medically, this guide on vaginal odor and BV is a solid place to start. For a broader view of causes, symptoms, and treatments, check out the Bacterial Vaginosis main article.
And since BV can overlap with other feminine health changes in aging, I also recommend exploring long-term BV prevention strategies tailored to women 40+.
For a deep dive into how bacterial vaginosis fits into the broader landscape of women’s health topics—including diagnosis, sexual wellness, and natural remedies—visit the BV Pillar article. To understand BV’s place in overall vaginal health, start here from the main pillar page at Healthusias.
How Older Women Can Treat BV Effectively
When I was finally diagnosed with BV, I was both relieved and overwhelmed. My doctor walked me through the standard options, but I also did my own digging—because I wanted more than just a temporary fix. If you’re over 40 or postmenopausal, your approach might need a little tweaking.
Prescription Options Still Work (But Pay Attention)
The go-to meds are usually:
- Metronidazole (oral or gel)
- Clindamycin cream
- Boric acid suppositories (especially for recurring BV)
I had success with metronidazole gel, but the fishy odor crept back within a few months. That’s when I realized treatment isn’t just about knocking out bacteria—it’s about supporting your body long-term.
Probiotic Support and BV
Adding a daily probiotic made a surprising difference for me. I started with probiotics for BV—specifically strains like Lactobacillus reuteri and rhamnosus. They help rebuild the vaginal microbiome after treatment.
Just make sure you’re taking the right type and consistency matters. I take mine at bedtime with a light snack, which my gynecologist said might help colonization.
Lifestyle Habits That Help Keep BV From Returning
Switching Up Intimate Hygiene Routines
BV taught me to simplify. I ditched fragranced soaps, body washes, and pantyliners with synthetic materials. Instead, I now use a pH-balanced, unscented cleanser just once a day externally. A helpful article I leaned on was this vaginal hygiene guide.
- No douching—ever
- Switch to 100% cotton underwear
- Avoid wearing tight pants for too long
Also, after workouts or swimming, I now change out of wet clothes immediately. Moisture creates a breeding ground for bacteria, especially when estrogen levels are low.
Diet and BV: Way More Connected Than You’d Think
One thing that really surprised me? The foods I was eating might have been feeding the “bad” bacteria. There’s some strong research behind this, and even my doctor nodded when I mentioned diet. Articles like this one on foods to avoid were eye-opening.
Now, my daily choices include:
- Fermented foods like kefir and sauerkraut
- Fewer refined carbs and sugar
- Hydration—more than I thought I needed
It’s not about perfection. But cutting back on sugar and increasing probiotics made me feel more balanced overall, not just “down there.”
What If It Keeps Coming Back?
Recurrent BV is something I wouldn’t wish on anyone. But it’s real—and more common in older women than most realize. After my third round of symptoms in one year, I had to rethink everything.
Steps I Took That Actually Helped:
- I began journaling my symptoms and triggers
- I spaced out my antibiotic use and added natural support in between
- I started using boric acid vaginal suppositories for maintenance
It’s not foolproof, but I’ve gone nearly a year without another flare-up. Everyone’s body is different, but layering your strategies makes a big difference.
When to Talk to a Specialist
If symptoms persist despite trying the basics, it might be time to consult a menopause-informed gynecologist. BV can look similar to atrophic vaginitis, a condition many women get post-menopause due to thinning vaginal walls.
You might benefit from:
- Topical estrogen or low-dose vaginal hormone therapy
- Revisiting your treatment routine with updated lab tests
- Exploring whether gut health is playing a role (surprisingly common!)
And don’t be afraid to ask your provider about alternative treatments. I brought up tea tree oil, and while it wasn’t their first suggestion, we had a really productive conversation about what’s safe to try at home.
Staying Empowered Through Education and Community
I used to feel weird bringing up BV with friends. But once I did, several admitted they’d dealt with it too. That shame? Gone. We even started sharing resources, and honestly, this guide on stopping recurring BV has been shared in our group chat more times than I can count.
If you’re still navigating this, explore the larger resource on how to naturally balance your vaginal pH—it covers strategies that go beyond the basics and respects where you are in your health journey.
For broader guidance tailored to managing and preventing intimate health issues at any age, the main BV hub is worth bookmarking. You’ll find structured info, but without the scary clinical tone. For more holistic strategies on prevention and full-body wellness, the Pillar article on natural remedies is full of useful tips.
Dr. Gwenna Aazee is a board-certified Internal Medicine Physician with a special focus on hypertension management, chronic disease prevention, and patient education. With years of experience in both clinical practice and medical writing, she’s passionate about turning evidence-based medicine into accessible, actionable advice. Through her work at Healthusias.com, Dr. Aazee empowers readers to take charge of their health with confidence and clarity. Off the clock, she enjoys deep dives into nutrition research, long walks with her rescue pup, and simplifying medical jargon one article at a time.
