What is the Best Probiotic Supplement for Women?

Kathy Wheddon Nutritional Therapist DipION

Research shows that different probiotic strains (types) do different things, which means they are not one-size-fits-all. Therefore, the best one for you depends on your individual needs. Many probiotics are beneficial for both women and men, but there are several strains that have been shown to be particularly beneficial in supporting women’s health. Whether you are looking to support your gut health or intimate health, this article will pinpoint the best probiotics for you. Learn more by reading What are probiotics?

Woman smiling
To stay happy and healthy, don't forget your 'intimate' flora!

Where should I start?

When we are looking at the top probiotics for women to take, we need to consider the microbiomes of two separate anatomical areas, the gastrointestinal tract and the urogenital system. Beneficial micro-organisms inhabit the urinary tract and vagina in women1, as well as the gut. In the vagina and urinary tract, these helpful microbes are thought to exert many of the same beneficial effects as they would in the gut. Their presence limits the likelihood of pathogenic bacteria and yeasts being able to overgrow, causing conditions such as: thrush, Urinary Tract Infections (UTIs) and Bacterial Vaginosis (BV). Healthy vaginal and urinary microbiomes are dominant in Lactobacilli bacteria which maintain an acidic vaginal environment, discouraging the growth of harmful bacteria and yeasts1,2. Learn more by reading All about the vaginal flora.

However, due to the proximity of the vagina to the anus, it is much easier for harmful microbes, including bacteria and yeasts, to cross over from the GI tract to the urogenital tract in women than in men3. This can upset the balance of the vaginal flora. In fact, most urogenital infections, like thrush, cystitis or UTIs, and bacterial vaginosis, are believed to stem from pathogens in the intestines. Healthy vaginal and urinary microbiomes consist of different strains of bacteria to those which reside in the gut microbiome, and hence should be considered separately when you are choosing a probiotic supplement.

Best probiotics for women's vaginal health

We are often asked: Do probiotics for women work? What is the best women’s probiotic for BV and/or thrush? It seems a reasonable assumption to make, that taking probiotic supplements can positively affect the flora of our urogenital system, and therefore help against UTIs and vaginal infections. Let’s take a look at some of the evidence to explore this assumption.

Various clinical trials have shown that a number of Lactobacillus strains are particularly effective in supporting female intimate health. Certain strains (such as Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14®) have been clinically trialled and shown to survive transit through the gut, and then successfully colonise the vagina. This is where they exert their beneficial effects. According to the researchers who conducted the study, "L. rhamnosus GR-1® and L. reuteri RC-14® can translocate to the vaginal environment even if they are taken orally" and "Their administration results in significant changes in the vaginal flora in terms of increased Lactobacilli presence…"4. Healthcare professionals can learn more about the research behind Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® on the Probiotics Database.

Bacterial vaginosis

As BV is the most common type of vaginal infection in premenopausal women5, finding a safe and natural approach to treatment/prevention would be a huge ‘win’. One particular study, a randomised, placebo-controlled trial6, showed that the vaginal microflora in women with Bacterial Vaginosis (BV) was restored to a more favourable, Lactobacilli-dominant environment following two months of daily oral intake of the probiotics Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14®.

Pregnant women often suffer with intimate health infections due to the hormonal changes taking place during gestation. It is important for both the health of mother and baby that an expectant mother has a healthy vaginal microbiome, as during a normal vaginal delivery the mother passes on some of her resident microflora to her newborn. This transference of bacteria from mother to baby influences the health of the baby’s microbiome. 

In 2018 a clinical trial7 showed that the probiotic strain Lactobacillus rhamnosus HN001 (in conjunction with Lactobacillus acidophilus La-14® and lactoferrin) can help reduce symptoms of BV such as itching and discharge. Vaginal swabs were taken at the start of the trial and forty pregnant women (all of whom tested positive for intermediate BV) were given either the probiotic combination, or placebo. By day 15 of the trial, repeat vaginal swabs of the participants in the probiotic group demonstrated an improvement in symptoms as indicated by a reduced Nugent score, with an increased cure rate in comparison to those in the placebo group.

Mechanisms of action 'For Women'

Urinary tract infections

The urinary and vaginal microbiomes contain similar types of bacteria and in healthy individuals, Lactobacilli dominate in both regions1. The probiotic strains, Lactobacillus rhamnosus GR-1®, Lactobacillus reuteri RC-14®8, and Lactobacillus crispatus9 have been reported to support a healthy urinary microbiome in those who experience recurrent UTIs. Healthcare professionals can learn more by reading Probiotics for UTI – A look at the research on the Probiotic Professionals site.

Thrush

Some women find that they may become more prone to thrush at certain points in their menstrual cycle, during pregnancy and when taking the combined oral contraceptive pill or hormonal replacement therapy. When oestrogen levels are high, Candida, the yeast responsible for thrush, thrives10. A probiotic supplement that contains the well-researched Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® strains may help those prone to thrush, as they may help inhibit the growth of harmful bacteria and yeasts, such as Candida, in the vagina11. Healthcare professionals can learn more by reading Which probiotics help with thrush? on the Probiotic Professionals site.

Best probiotics for women's digestive health

As mentioned, the vaginal flora is affected by different probiotic strains to those recommended for gut health. Whilst the question of the best probiotic strains for digestive health conditions is not gender-specific, here we explore a few digestive conditions which are reported to be commonly experienced by women.

Bloating

One frequently reported symptom to consider when discussing probiotics specifically for female gut health, is bloating. This may be a constant problem, or the bloating may be cyclical and worsen at certain times of the menstrual cycle (e.g. premenstrual bloating) or around menopause.

We are often asked what causes bloating in women. There are several factors that can lead to a swollen, uncomfortable abdomen: fluctuating hormone levels, stress, poor diet or disturbed digestion (IBS, food intolerances for example), to name a few. Upset digestion associated with menstruation is very common, including alterations to bowel patterns, constipation, diarrhoea, nausea, abdominal pain and bloating12. Fluctuating levels of female sex hormones, oestrogen and progesterone, and the body’s sensitivity to these fluctuations is thought to contribute to the sensation of bloating that occurs around menstruation13. Certain probiotic strains may help to alleviate this bloating and digestive discomfort, such as Lactobacillus acidophilus NCFM®. You may like to read the following blog: ‘Bloating – all you need to know’ to learn more.

Bloated woman

Many women experience a bloated stomach in menopause that might be relieved with a few simple measures to look after their gut health, and the health of the microbiome. With that said, bloating should never be overlooked. If it is a concerning issue, it should be checked over by a GP, as bloating can be signs of more serious conditions. Healthcare professionals can learn more by reading Could probiotics help with menopause symptoms? on the Probiotic Professionals site.

Constipation

Constipation is more frequently reported in women than men14, often occurring around menstruation, during pregnancy and post-menopause. A probiotic supplement containing Bifidobacterium lactis BB-12® can help support gut health in those with constipation. B. lactis BB-12®, along with fructo-oligosaccharides (a prebiotic), can help gently encourage regular bowel movements, as supported by one of the largest clinical trials performed on probiotics15. Health professionals can read more about the research behind this strain on the Probiotics Database: Bifidobacterium lactis BB-12®.

Alterations to normal bowel patterns, including constipation, can occur as a part of Irritable Bowel Syndrome (IBS). Symptoms of IBS, including abdominal discomfort and disrupted bowel patterns, can be exacerbated around the time of menstruation in those with menstrual cycles and in perimenopausal women16. To learn more about how to support gut health in IBS, read Which probiotics are for IBS?

Go with your gut feeling

When selecting a probiotic supplement, choose the one that feels right for you. If you are seeking specific benefits, consider a friendly bacteria supplement with research behind it for this particular purpose, for example if you are a woman looking for intimate health support, consider a product containing the well-researched strains Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® which have been shown to help support a healthy vaginal microbiome17 and are among the best rated probiotics for women.

It is also worth noting that whilst the benefits of probiotics for women are many, any side effects are rare, making these supplements a popular choice for daily maintenance of gut and intimate health. Healthcare professionals can learn more about this topic by reading Probiotics and side effects – an in-depth review on the Probiotic Professionals site.

In Summary

  • Probiotic supplements for women can help support gut health and intimate health.
  • Probiotics can help to limit the overgrowth of harmful bacteria and yeasts that contribute to the development of gut and intimate health issues.
  • The vagina and urinary tract require different friendly bacteria to the gut to maintain a healthy microbiome. Therefore, choose specific probiotic strains that are well researched for their effects in each specific area.
  • The best probiotic supplements for intimate health contain probiotic strains such as Lactobacillus rhamnosus GR-1®, Lactobacillus reuteri RC-14®, Lactobacillus rhamnosus HN001 and Lactobacillus crispatus.
  • The best probiotics to support gut health in women, helping with complaints such as bloating and constipation, include Lactobacillus acidophilus NCFM® and Bifidobacterium lactis BB-12®

You can read more about women and probiotics here:

Probiotics & Bacterial Vaginosis

For more information regarding probiotics and constipation, healthcare professionals can read Probiotics for constipation on the Probiotic Professionals site.

References

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  2. Witkin SS, Linhares IM. Why do lactobacilli dominate the human vaginal microbiota? BJOG An Int J Obstet Gynaecol. 2017;124(4):606-611. doi:10.1111/1471-0528.14390
  3. Magruder M, Sholi AN, Gong C, et al. Gut uropathogen abundance is a risk factor for development of bacteriuria and urinary tract infection. Nat Commun. 2019;10(1). doi:10.1038/s41467-019-13467-w
  4. Morelli L, Zonenenschain D, Del Piano M, Cognein P. Utilization of the intestinal tract as a delivery system for urogenital probiotics. J Clin Gastroenterol. 2004;38(6 Suppl). doi:10.1097/01.mcg.0000128938.32835.98
  5. BASHH. Sexually Transmitted Infections in Primary Care 2013. 2014. https://www.bashhguidelines.org/media/1089/sexually-transmitted-infections-in-primary-care-2013.pdf.
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  7. Russo R, Karadja E, De Seta F. Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: A double blind, placebo controlled, randomised clinical trial. Benef Microbes. 2019;10(1):19-26. doi:10.3920/BM2018.0075
  8. Beerepoot MAJ, Mostert). Women with Recurrent Urinary Tract Infections : Antibiotic Resistance and Non-Antibiotic Prophylaxis. [s.n.]; 2013. https://dare.uva.nl/search?identifier=381af002-2eb8-4956-834f-3aef23760310. Accessed February 15, 2018.
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  11. Martinez RCR, Franceschini SA, Patta MC, et al. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol. 2009;48(3):269-274. doi:10.1111/j.1472-765X.2008.02477.x
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