WOMEN’S HEALTH
BY ACTIVATED PROBIOTICS March 4, 2025
There are many different factors that affect women’s health across the lifespan, and one very important one is the health of the microbiome. While the terms “microbiome” and “microbiota” are becoming more familiar with people as awareness builds on the important role that microorganisms play in health and disease, these terms are often linked with gut health. The gut microbiome is definitely an important player in our state of health, but the microorganisms living in different organs and tissues in our bodies also play a collective role in our health1.
With this exciting area of research, which continues to expand, it is clear that numerous aspects of women’s health can be optimised by attempting to understand how the human microbiota affects women’s physiology. Additionally, by learning how the microbiome affects various facets of women’s health, this also helps us to determine the best ways to support these microbial communities to keep women healthy, such as through the use of targeted, strain-specific probiotics.
In this article we will explore how the collective human microbiota and specific probiotic strains can impact common health concerns relevant to women including:
- Maintaining healthy iron levels
- Supporting optimal vaginal health, thereby reducing recurrence of common genitourinary conditions such as vaginal thrush or bacterial vaginosis
- Maintaining healthy pregnancies
- Preventing excessive bone breakdown and protecting against osteopenia and osteoporosis
It is now recognised that the microbiome plays a significant role in the state of human health. You may have heard terms such as the “gut brain connection”, or the “gut-bone axis”. Research continues to reveal that the gut microbiome can impact many different areas of health, including mental health, bone health, hormonal health, and more, making it highly relevant for women’s health and wellbeing.
“The gut microbiota has a strategic role in crucial moments at every stage of a woman’s life: From childhood to adolescence, from fertile age to pregnancy-partum, up to menopause2.”
For example, the gut microbiota is known to influence metabolism of the important female hormone oestrogen through its impact on the secretion of the enzyme β-glucuronidase, which is responsible for liberating oestrogen to its free form in the gastrointestinal tract (GIT)3, thereby rendering it free to circulate in the blood and exert various actions in the body. Certain health conditions in which oestrogen levels play a role, such as polycystic ovarian syndrome (PCOS), obesity, endometriosis, and breast cancer, can therefore be affected by microbial-derived β-glucuronidase activity. There are many other physiological processes impacted by the gut microbiome, and this is just one example of what makes it so important for health. Microbial communities all around the body also have significant effects on the health of the tissues and organs on which they reside, such as the skin and the vagina. The state of a woman’s vaginal microbiome has a significant influence on her risk of experiencing genitourinary infections, her fertility and pregnancy outcomes, and more.
Gut health is an important thing for women to prioritise, no matter which stage of life they are in. Firstly, it is recognised in the scientific literature that poor gut health symptoms are more prevalent in women - they tend to experience more severe gastrointestinal symptoms and a higher prevalence of functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome (IBS) compared to men4. This often results in not only experiencing uncomfortable digestive symptoms, but a reduction in quality of life for many women living with symptoms such as gas and bloating, constipation, diarrhoea, abdominal pain, and more. While there may be many factors implicated in the increased severity and prevalence of these symptoms in women, it is reassuring to learn that by addressing gut microbiome imbalance and poor gut health, symptoms (and quality of life) are likely to improve.
When the gut microbiome becomes out of balance, this is termed gut dysbiosis. Gut dysbiosis can compromise our digestive and immune health and can have far-reaching, systemic effects if left unaddressed. When specifically looking at women’s health, gut dysbiosis can be a significant determinant when it comes to absorbing iron, optimising pregnancy outcomes, maintaining a healthy mood, and supporting bone density, the latter of which is important for osteoporosis prevention with advancing age.
What are common causes of low iron (iron deficiency)?
Iron deficiency is a significant concern worldwide, especially since it is a major cause of anaemia, which affects 40% of pregnant women and 33% of non-pregnant women globally5. Iron is a crucial mineral in the human body which is needed for a whole host of biochemical processes, such as energy production, growth of cells, and oxygen transport5. Some common causes of iron deficiency may include6:
- Insufficient intake of iron through the food we eat
- Blood loss
- Malabsorption
- Systemic inflammation
The ability of our gastrointestinal tract to absorb iron is one of the most important factors which can determine a woman’s iron status. It is often assumed that the iron in the food we consume is a very significant source of usable iron for our bodies. However, most of the iron that enters the digestive tract may not actually be absorbed by the body. A person could be eating sufficient amounts of iron in their diet, however if their digestive tract is not in a healthy state and functioning as it should, they may not be able to effectively absorb iron. Iron malabsorption may therefore be a cause of low iron in cases where digestive health and the gut microbiome have not been considered for many women dealing with iron deficiency.
What are common treatments for low iron?
Iron deficiency treatment options provided by your doctor may include supplemental iron, of which ferrous fumarate, ferrous sulphate, and iron polymaltose are some commonly prescribed forms of iron7. In cases of very low iron which do not respond to oral treatment, or when side effects of iron tablets are intolerable, some women may be advised to take iron intravenously which is a procedure done in the clinic with their GP.
Do iron supplements have side effects?
Unfortunately, many conventionally prescribed iron supplements may cause unwanted side effects, many of which cause digestive symptoms such as nausea, constipation, diarrhoea, flatulence, abdominal pain, or very dark, tarry looking stools. These iron supplement side effects arise as a result of these commonly prescribed forms of iron having an oxidative or pro-inflammatory effect in the gut and negatively impacting the gut microbiota8. Many women may find that their digestive systems may not tolerate some iron supplements. How then can we optimise iron levels without causing more inflammation in the gut? While the cause of low iron levels can be multifactorial and will depend on an individual’s unique physiology and circumstances, absorption via the gastrointestinal tract is an important underlying cause to address. Targeted probiotic strains have been clinically shown to help optimise iron absorption, helping to improve our gut health, our microbiome balance, and our ability to absorb iron from the digestive tract. In fact, it has been acknowledged in the scientific literature that harnessing the power of specific probiotics could be one of the best clinical tools for optimising absorption of dietary iron, thereby reducing the gastrointestinal impact of iron tablets, side effects, and subsequently poor digestive health and suboptimal iron status9.
Can probiotics improve iron absorption?
Absorbing iron effectively via the gastrointestinal tract depends on many factors, and while it is important to investigate individual contributors under the guidance of a health practitioner, probiotics are an easy way to help us to absorb iron. A specific probiotic strain known as Lactobacillus plantarum 299v has been shown in clinical trials to help increase intestinal iron absorption. In one study, healthy menstruating women were served an iron-fortified fruit drink either with or without L. plantarum 299v. The results demonstrated a 49% increase in iron absorption from the fruit drink enriched with L. plantarum 299v which was statistically significant when compared to those women who did not take the probiotic10. In a subsequent clinical trial, the rate of iron absorption from a light breakfast meal administered with or without capsules containing L. plantarum 299v was studied in healthy female participants. The researchers observed that when women took the probiotic, their ability to absorb iron increased by 23% compared to not taking the probiotic alongside the meal11. Studies examining the potential mechanisms behind how L. plantarum 299v enhances iron absorption have shown that this microorganism can increase the function of certain cellular processes involved in absorbing iron across the gut lining12,13. In addition to its ability to maximise gastrointestinal iron absorption, intake of L. plantarum 299v has been shown to significantly reduce unpleasant gastrointestinal symptoms such as abdominal pain14, highlighting its potential to also help combat some of the common gastrointestinal side effects seen with oral iron supplementation.
While probiotic supplementation has been shown to support the health and wellbeing of women via action on the gut microbiome, such as via improving absorption of crucial nutrients like iron, probiotics are also effective for the vaginal environment, specifically by supporting the vaginal microbiome.
What is the vaginal microbiome?
The vaginal microbiome refers to the unique community of microorganisms residing within the vaginal environment. Unlike the gut microbiota which benefits from having a great diversity of different microorganisms living there, a healthy vaginal microbiome is characterised by low diversity, with dominance of a certain group of bacteria known as lactobacilli. Lactobacilli produce lactic acid, which helps to maintain an optimally acidic vaginal pH (which is around 3.5-4.5) and keep pathogenic (disease-causing) microorganisms from taking hold and causing unpleasant symptoms and infections15. Optimal vaginal health is all about keeping the vaginal microbiome balanced. However, it is possible (and common) for the vaginal microbiome to become unbalanced. This is called vaginal dysbiosis. Vaginal dysbiosis can leave women vulnerable to uncomfortable infections like vaginal thrush, bacterial vaginosis (BV), and urinary tract infections (UTIs).
What are symptoms of vaginal dysbiosis?
When the vaginal microbiome is out of balance, vaginal dysbiosis can lead to inflammation of the surrounding tissues (termed vaginitis), which can present as unpleasant symptoms like itching, redness, odours, and discharge. Some of the most common causes of vaginitis are recurring BV and vulvovaginal candidiasis (also referred to as thrush)15.
What causes bacterial vaginosis (also known as BV)?
Bacterial vaginosis (BV) is caused by an overabundance of certain types of bacteria usually at lower levels within the vaginal microbiome, with a relative deficiency of lactobacilli, resulting in a disrupted and unbalanced vaginal microbiome (16). Reduced lactic acid producing bacteria in the vaginal environment leads to an increased vaginal pH, which can therefore result in an overgrowth of a range of these microorganisms, such as Gardnerella vaginalis. Some of the factors which initially disrupt the ideal balance of vaginal flora, and thus create the potential for BV to occur may include recent antibiotic use, contraceptive use, unprotected sex, smoking, and other factors16. When untreated, BV has been associated with increased risks of sexually-transmitted infections, preterm birth, early pregnancy loss, low infant birth weight, increased neonatal morbidity, higher rates of postpartum endometritis (inflammation of the lining of the uterus) and pelvic inflammatory disease15,17.
What are symptoms of bacterial vaginosis?
A key feature of BV is a “fishy” odour which is due to the overgrowth of certain bacteria which produce compounds that generate this odour. This can often (but not always) be accompanied by a grey, milky, discharge. Some women with BV may also experience symptoms such as irritation, burning, or pain. It is estimated that 50% of women with BV do not experience any distinct symptoms, so this highlights the importance of seeking appropriate referral for examination to rule out BV16.
Are probiotics a treatment for bacterial vaginosis or recurring BV?
Bacterial vaginosis treatment often involves antibiotics, which can be effective for short-term relief, however 25% of women will experience a recurrence within 4 weeks, and up to 50% within 3 months15. It’s also estimated that 70% of women will experience long-term recurrence. Particularly in those with recurrent symptoms, many women experience anxiety, shame, and concerns about hygiene, as well as a reduced quality of life. With such high rates of recurring BV and its negative impacts on health and wellbeing, there is a clear need to find alternative solutions to address the underlying cause (vaginal dysbiosis).
Probiotics for BV are a promising form of BV treatment to help re-establish a healthy, balanced vaginal microbiome. While there are a number of probiotics for vaginal health available, it is important to look for a probiotic which is specifically formulated to help address vaginal dysbiosis by supporting the population of lactobacilli in the vagina, which in turn helps to regulate the acidity of the vaginal environment and prevent the overgrowth of potentially problematic microorganisms. One particular species, Lactobacillus crispatus has demonstrated the most protective effects against vaginal dysbiosis18.
What is vaginal thrush (also called candidiasis)?
Vulvovaginal candidiasis (VVC) or vaginal thrush is caused by an overgrowth of a group of fungal species from the genus Candida, with 90% of cases due to overgrowth of the species Candida albicans19. While Candida species are naturally found as members of the vaginal microbiome, they may become opportunistic and overgrow in the vaginal environment when certain factors disturb lactobacilli balance (i.e. antibiotic use, blood sugar dysregulation). This disturbance reduces the protective effects of lactobacilli, such as optimal acid levels, production of antifungal substances and taking up physical space, which would otherwise keep Candida levels in check19.
What are symptoms of vaginal thrush?
Women with vaginal thrush tend to experience a milky or curd-like discharge, which is the result of Candida species growing and expanding throughout the vulvovaginal environment. This is often accompanied by vulvovaginal irritation, burning, and sometimes pain while urinating19.
Are probiotics a treatment for vaginal thrush?
Vaginal thrush treatment often involves oral and / or topical antifungal medications such as fluconazole. Unfortunately, of all women treated with standard oral antifungals such as fluconazole, recurrence occurs in up to 57% within 6 months, while almost 1 in 10 women experience recurrent VVC (RVVC), which is defined as at least 4 episodes occurring within a 12 month period19,20. Using other clinically proven strategies such as specific probiotics for thrush are therefore needed to help reduce symptoms and enhance quality of life by helping to re-establish balance of the vaginal microbiome. For example, a clinical trial in 58 women with recurrent RVVC (recurrent thrush) observed that the probiotic strains Lactobacillus fermentum LF10 and Lactobacillus acidophilus LA02 prevented recurrence of symptoms in 72.4% of women who took the probiotic, with alleviation of symptoms observed for 7 months after taking the probiotic20. Research continues to demonstrate how specific probiotic strains can support the health of the vaginal microbiome, having important implications for women’s health.
Common medications such as antifungals and antibiotics often provide short-term relief for common conditions associated with vaginal dysbiosis, but recurrence of symptoms is common since these medications do not correct the underlying microbial imbalance. Using targeted probiotics for vaginal health can be a simple, convenient, and effective way to restore and maintain vaginal microbiome balance by supporting health-promoting groups of microorganisms such as lactobacilli.
What are common health concerns related to bone health?
Bone density is one of the most important aspects of bone health. Throughout childhood, adolescence and early adulthood, our bones are being strengthened by the action of bone-building cells called ‘osteoblasts’. Bone density helps to protect our bones from fracturing. However, our bones begin to lose their density as we reach older adulthood. Age-related changes and increasing inflammation slow down the activity of osteoblasts and increase the activity of cells that break down bone called ‘osteoclasts’. For women, this occurs much more rapidly after menopause with the loss of oestrogen. This important hormone has a protective effect on bones, and this is why high rates of bone density loss are particularly observed in the early post-menopausal period21.
What are common health concerns related to bone health?
Some of the most common health concerns related to bone health for women are osteopenia and osteoporosis. Osteopenia is the precursor to osteoporosis, in that it is characterised by lower than what is considered normal bone density (a T-score on a bone scan between -1 to -2.5), whereas progression to osteoporosis is characterised by a bone density scan showing a T-score less than or equal to -2.522. Women are at greater risk of developing osteoporosis than men due to their smaller bone size, lower peak bone mass, and the rapid loss of bone density which occurs following menopause23,24. Other potential risk factors for accelerated bone density loss in women include history of breast cancer treatment, early or medically-induced menopause, eating disorders such as anorexia nervosa, and coeliac disease25.
What are common treatments for osteoporosis?
If osteoporosis is diagnosed or someone is at risk for developing osteoporosis, treatment will depend on their individual level of risk and disease progression. For example, if your doctor observes a lower than normal bone density reading on your scan, one of the first things they may want to ensure is that your vitamin D and calcium levels and intake are adequate, and that you are keeping physically active25. When it comes to standard osteoporosis treatment however, this usually involves prescription of medications which slow the activity of bone-degrading cells (called “osteoclasts”), which allows bone-forming cells (called “osteoblasts”) to continue building bone26. Bisphosphonates (such as denosumab) are a common example of medication commonly prescribed as osteoporosis treatment, however menopausal hormone therapy (MHT) or other drugs which help to mimic the bone-protective effects of the hormone oestrogen may also be used for women with osteoporosis. While these medications can be helpful, side effects can happen in some women who take them, however even if they do respond, research is beginning to highlight that the health of the gut microbiome has a significant influence over the health of our bones - a factor that these medications do not tend to address.
How can you help prevent osteoporosis?
Osteoporosis prevention is an important priority for women, especially with advancing age, for the reasons outlined above. While maintaining adequate vitamin D, calcium, and physical activity are great things to focus on in this respect, there is one area worth focusing on for osteoporosis prevention which is perhaps less well known, and that is the gut-bone axis.
The gut-bone axis refers specifically to the gut microbiota’s communication with bone tissue. The gut microbiota interacts with immune cells in the gut, which then carry messages to our bones. For example, there are specialised cells in bone tissue which are responsible for breaking down bone, and these are called ‘osteoclasts’, and their activity is increased with the presence of certain inflammatory mediators produced by the immune system27. Osteoclast activity ramps up as we age, mainly due to an increase in inflammation seen with advancing age (this is sometimes termed “inflammaging”). Because a significant portion of our immune system (around 70%)28 is found just beneath the surface of the gut lining, this means our gut microbiome is in direct communication with immune cells, thereby having an influence on the inflammatory messages they produce. By altering the types of inflammatory messages produced by the immune system, the gut microbiome can reduce the activity of osteoclasts and thus help to preserve bone mineral density. Enhancing the health of the gut microbiota can therefore help dampen the inflammatory messages that increase bone breakdown via their effects on the immune system29.
Can probiotics support healthy bone density?
Given the importance of the role of the gut-bone axis in maintaining bone density, specific probiotic strains have indeed been shown to reduce the rate of bone density loss. Specifically, the strains Lactobacillus plantarum HEAL9, Lactobacillus plantarum HEAL19, and Lactobacillus paracasei 8700:2 showed promising results when given to 249 healthy, early post-menopausal women for a period of 12 months. At the end of the study, the researchers observed a 78% reduction in the rate of bone density loss when taking these probiotic strains compared to taking the placebo30.
Does your microbiome change during pregnancy?
During the various stages of pregnancy, there are normal changes to the microbiome which are part of the body’s changing physiology to accommodate a growing baby, with many of these changes influenced by fluctuating reproductive hormones such as oestrogen and progesterone. For example, it has been observed that there is an increase in inflammation at implantation and in labour, whilst there is more anti-inflammatory microbiome activity in mid-pregnancy especially regarding the placenta to minimise the chance of foetal rejection31. As a woman’s pregnancy progresses, the gut tends to experience low-grade inflammation which is a natural and normal change observed in pregnancy. However, it is when metabolic conditions change (such as in obesity and gestational diabetes) that this low-grade inflammation can tip from being physiologically normal to a more dysfunctional state which can compromise the health of the growing baby31.
Both the gut and vaginal microbiota play a critical role in determining many facets of maternal and foetal health. For example, a balanced vaginal microbiome is associated with healthy pregnancy and a reduced risk of pregnancy-related complications, while the gut microbiome is thought to be essential for maternal metabolic health and foetal immune development. Modifying and restoring microbial health may therefore significantly help in the prevention of pregnancy related complications.
Can probiotics support a healthy pregnancy?
When it comes to supporting a healthy pregnancy, probiotics can be an effective and safe tool which are easily incorporated into a daily routine. Probiotic supplementation during pregnancy has been shown to have a number of metabolic benefits, including improved blood glucose control (in conjunction with dietary counselling)32 and insulin sensitivity31. Further, probiotic supplementation has been shown to reduce the frequency of gestational diabetes34,35, a common condition which is on the rise in Australia, affecting around one in six pregnant women, and is characterised by persistently high blood sugar levels during pregnancy36. Pregnant women with gestational diabetes have pro-inflammatory changes in the gut microbiome compared to pregnant women with normal blood sugar regulation37. Two probiotic strains in particular, Lactobacillus rhamnosus GG and L. rhamnosus HN001 have shown promising results in clinical studies, effectively supporting women with gestational diabetes through pregnancy34,35.
Another interesting area of research in pregnancy points to the role of the gut-brain axis, which, much like the gut-bone axis discussed earlier, describes the bidirectional communication between the gut microbiota and the brain. Mood disturbance can be a significant health concern faced by women throughout and after pregnancy, with hormone-induced alterations to the gut microbiome thought to impact mood, emotional regulation, and overall mental health via complex interactions with the brain38. In an exciting area of research, probiotic supplementation during pregnancy and postpartum has shown to significantly improve feelings of anxiety and depressed mood. One clinical study administered the probiotic strain L. rhamnosus HN001 to women daily from 14-16 weeks gestation until 6 months post-birth (whilst breastfeeding). After 380 of the participants completed a psychological assessment post-birth, it was found that HN001 administration was associated with significantly better mood compared to placebo.
Finding the best probiotic for women involves selecting the right formulation which is well-suited to a woman’s individual health needs at the time. Many probiotics for women may not be condition-specific and backed by clinical evidence, however these are important qualities to look for when it comes to seeking out some of the best women’s probiotics. For example, if iron absorption is something that needs to be prioritised, a product like Biome Iron+™ Probiotic is specifically formulated to boost gastrointestinal absorption of iron to help gradually and gently restore iron alongside sufficient dietary intake and iron supplementation if necessary. For pregnant women and those looking to conceive, the probiotic strains in Biome Prenatal+™ Probiotic have been clinically shown to support a healthy pregnancy. Probiotics for women which are also tailored to specific lifestages are helpful, such as Biome Osteo™ Probiotic which is well-suited for older women to help support healthy bone density at a time when bone density steadily declines with age. In regards to specific support for the vaginal microbiome, the best probiotic for women in this case might be Biome Her™ Probiotic, as the formulation of strains used in this probiotic supplement have been shown to positively impact the vaginal environment, thereby helping to restore vaginal microbiome balance.
While there are many factors influencing a woman’s health across her lifespan, the role of the gut microbiome is evidently a very important one! So take care of your gut microbiome, and it will take care of you. Targeted probiotic strains can be one of the easiest ways to start to nurture your gut, so make sure to consult with your health practitioner to help choose the right probiotic for you which best suits your current needs at the lifestage you are in.
In the spirit of reconciliation, Biome Australia acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community.We pay our respect to their elders past, present and emerging, and extend that respect to all Aboriginal and Torres Strait Islander peoples today.
Stay up to date with us!
Creators & Distributors of Activated Probiotics
192-194 Johnston St,
Collingwood VIC 3066
Always read the label. Use only as directed. If symptoms persist consult your health professional.
