Best probiotic for the menopause: which one should you choose?

Why does the menopause alter the microbiota?

The role of oestrogen

Oestrogens indirectly influence the composition of the vaginal microbiota. In particular, they promote the accumulation of glycogen in the cells of the vaginal epithelium. As these cells are renewed, this glycogen is gradually converted into sugars that can be utilised by Lactobacillus, lactic acid bacteria that produce lactic acid and help maintain an acidic vaginal pH, which is not conducive to the growth of opportunistic microorganisms. With the onset of the menopause, the fall in oestrogen levels reduces the amount of glycogen available, which is associated with a decline in Lactobacillus and a gradual imbalance in the vaginal flora. (1).

The decline in Lactobacillus

The decline in Lactobacillus populations, which usually dominate the vaginal microbiota in women of childbearing age, can therefore lead to:

• a reduction in the production of lactic acid and other protective substances;
• an increase in vaginal pH;
• the proliferation of undesirable bacteria and yeasts;
• an increased risk of vaginal discomfort, vaginal dryness or recurrent urinary tract infections in some women (2).

The estrobolome

The gut microbiota plays a role in oestrogen metabolism through a group of bacteria known as the estrobolome. These microorganisms produce, in particular, enzymes capable of transforming oestrogens excreted by the liver, thereby influencing their reabsorption and availability within the body (3).

Whilst its exact role in postmenopausal women remains to be clarified, several studies suggest that an imbalance in the estrobolome could contribute to the hormonal, metabolic and inflammatory changes observed after the menopause (4).

More generally, reduced diversity of the gut microbiota is thought to be associated with an impairment of the intestinal barrier and changes in the immune response, which may promote a state of low-grade chronic inflammation (inflammaging) (5).

These findings explain why researchers are taking an increasing interest in probiotics as a potential tool to support this transitional period, in terms of both the vaginal microbiota and the gut microbiota.

A recent meta-analysis confirms the potential benefits of probiotics during the menopause

An initial meta-analysis, published in 2025, compiled the results of 39 studies involving 3,187 perimenopausal or postmenopausal women (6). Its aim was to assess the benefits of probiotics, either alone or in combination with oestrogenic substances such as oestriol or isoflavones, in managing the main symptoms of the menopause.

The authors report beneficial effects on several parameters. In particular, probiotics appeared to help alleviate vasomotor symptoms, such as hot flushes, improve certain psychological symptoms, reduce vaginal dryness and promote a better balance of the vaginal microbiota. Potential benefits were also observed in relation to bone health, as well as the efficacy and tolerability of treatments based on oestriol or isoflavones.

However, the meta-analysis did not reveal any significant improvement in somatic symptoms or sexual dysfunction.

Results from a meta-analysis published in 2025, combining 39 studies involving 3,187 perimenopausal or menopausal women.

Research into the effects of probiotics on the gut microbiota of postmenopausal women is still in its early stages. However, several strains of Lactobacillus have already shown encouraging results. In animal studies, Lactobacillus acidophilus has notably been associated with better preservation of bone mineral density, whilst Lactobacillus intestinalis YT2 has helped to correct gut dysbiosis following oophorectomy (7). This initial research supports the potential of probiotics as a non-hormonal supportive treatment, but larger-scale clinical trials remain essential to confirm these benefits.

Which probiotics appear to be the most promising during the menopause?

Lactobacillus strains to maintain vaginal balance

As explained above, in menstruating women, the vaginal microbiota is generally dominated by various species of Lactobacillus. By producing lactic acid, these bacteria help to maintain an acidic environment that is unfavourable to the proliferation of certain undesirable microorganisms.

Not all strains within the same species are equivalent. Consequently, not all strains of Lactobacillus possess the same properties. Among those best documented in the field of women’s health are Lactobacillus rhamnosus, which naturally colonises the gut and vaginal flora; Lactobacillus reuteri, often combined with L. rhamnosus in studies on the balance of the vaginal microbiota and urogenital health; and Lactobacillus acidophilus (8).

A good initial strategy is therefore, for example, to combine the probiotics Lactobacillus rhamnosus GG and Lactobacillus reuteri.

For an even more comprehensive approach, the Vaginal Health formula combines five microorganisms — L. rhamnosus ATCC 53103, B. lactis, L. salivarius, L. acidophilus and L. casei — along with fructo-oligosaccharides, which serve as a substrate for them.

Probiotics for the gut microbiota

In regards to the gut, research remains at a preliminary stage and focuses on a variety of objectives: microbial diversity, integrity of the gut barrier, inflammation, metabolism and even estrobolome activity.

From this perspective, multi-strain formulations combining Lactobacillus, Lactococcus and Bifidobacterium are beneficial as they provide a wide diversity of microorganisms and support the gut ecosystem as a whole (9).

Full Spectrum Probiotic thus combines 20 microorganisms, including B. breve, B. bifidum, L. rhamnosus, L. plantarum, L. paracasei, L. casei and L. acidophilus.

Other ways to manage the menopause more effectively

Probiotics are just one part of a broader approach to managing the menopause. Diet, physical activity and, depending on individual needs, certain targeted supplements can also help restore comfort during this transitional period.

Adopting a high-fibre diet

Fermentable fibre found in vegetables, fruit, pulses, whole grains, nuts and seeds nourishes certain gut bacteria. Their fermentation leads, in particular, to the production of short-chain fatty acids, metabolites involved in maintaining the intestinal barrier and in the interactions between the microbiota and the immune system. Several studies have also highlighted the protective role of a high-fibre diet in the development of metabolic syndrome and depressive symptoms in postmenopausal women (10–11).

Staying physically active

Exercise helps to preserve muscle mass and bone density, two factors that are particularly important after the menopause. It also contributes to weight management, cardiovascular health, sleep quality and psychological well-being. Ideally, you should alternate between endurance activities — such as brisk walking, cycling or swimming — and strength training, with consistency being more important than intensity (12).

Consider targeted supplements

Shatavari (Asparagus racemosus) is a key plant in the Ayurvedic tradition associated with women’s wellbeing. In India, it is regularly used by women going through the menopause (13). Its roots contain steroidal saponins known as shatavarins. A clinical study involving 70 female patients aged between 40 and 65, who were given the Aspurus® extract – standardised to 5% shatavarins – for 8 weeks, reported an improvement in several symptoms (hot flushes, night sweats, fatigue, etc.) that can impair quality of life.

An extract at the heart of the Super Shatavari supplement.

For a more holistic, non-hormonal approach, certain plants and micronutrients can be utilised. These include black cohosh, which helps ensure a calmer and more comfortable menopause; fennel, which has been extensively studied for its effects on vasomotor symptoms and mood; and magnesium, which supports the normal functioning of the nervous system and normal psychological function (14–16).

All these ingredients are combined in Menopause Support, a comprehensive formula free from synthetic hormones and soya isoflavones, which also contains vitamins D3 and B6.

The menopause is also accompanied by a significant drop in the production of progesterone, a steroid hormone naturally secreted by the ovaries during a woman’s reproductive years (17). This decline in production may exacerbate certain discomforts experienced during the menopause. External progesterone supplementation may therefore be considered, always under medical supervision and following an assessment of the benefits and contraindications.

Natural Progesterone Cream contains natural progesterone, extracted from wild yam, in a formulation designed for enhanced absorption.

This same form of natural progesterone is also available in Natural Progesterone Spray, a very convenient spray format also designed for topical application.