My last post detailed the extent that those with endometriosis have dysbiosis of the reproductive tract and, more importantly, how closely associated it is with numerous aspects of endometriosis. I think we can all agree, after reading it, this is an issue that needs to be addressed. In this post, I will detail the HOW.

First Check In to See if This Is Even Relevant to You

It can be smelly and itchy or have no symptoms, with discharge or without, or maybe you’re lucky and have a pretty balanced microflora. The only way to know is to test. Luckily, if you have $6.99 (the price of pH paper, such as this one) you can check TODAY! Woot woot! How often do we get such quick results?!? Sorry, too excited about this super cheap, super easy, everyone-with-endo-should-so-ASAP test.

How to: Simply coat a clean Q-tip with vaginal fluid and smear on the paper. Watch as your results instantly appear! [Note these results aren’t diagnosing you with anything specific, just pointing to possible dysbiosis levels].

If you are in the 3-4 area (a healthy vaginal biome should be relatively acidic, between 3.9 and 4.4) then congrats! Having an acidic vagina is indicative of healthy Lactobacillus levels, the should-be-predominant microbe in the genital tract, a beneficial microorganism that produces a highly acidic medium called lactic acid. Lactic acid keeps a healthy vagina acidic enough to keep pathogens and other potentially harmful invaders from causing harm. If this is you, super healthy levels, you probably don’t need to really worry about this avenue for your type of endo. High five.

Unfortunately, 4 out of 5 women with endo were shown to be above the healthy pH range, testing anywhere from 4.5 to a shocking 9.0! When your pH is skewed basic like this (the opposite of acidic) it means that healthy lactobacillus is reduced, which makes it homier for pathogenic species to flourish. So if you’re out of range around, say 5, you can assume you have a little bit of dysbiosis going on. If you’re in the higher range, say 8, know there may be something significant, perhaps even clinically relevant (like a big fat diagnosable infection). The further away from 4 you are, the more serious your case of dysbiosis is going to be, and the more symptoms you have (or inability to conceive). (1)

If my pH is high, what should I do next?

There are many ways your “down-South-biome” can become off-kilter, which means there are many ways to help it back into balance.

The first one is a big one, and involved your bacterial mothership: the gut. Your gut microbiome seeds all your other biomes, so if you have a big overgrowth of e. coli in the gut, you can just about bet it will also be found in the reproductive tract biome. Why the gut is imperative to heal as a foundation, and why diet makes a difference.

These easy-but-not-to-be-overlooked  swaps include:

• Lowering sugar, alcohol, and refined food intake. I’ve had clients with recurrent yeast infections for years that ended them in a month with the removal of these foods.

• Increasing water and low starch vegetable consumption. Sounds easy, right?

• If you eat a lot of fruit, beans, and grains (high starch/sugar whole foods, basically), cut the habit down to no more than 1 serving per meal of any of these foods for a while. Swap in low to moderate carb veggies and quality protein instead. When I myself switched from high starch vegetarian to a lower starch diet with choice animal protein my reproductive tract issues cleared up totally.

• Of course, if you have something like SIBO, or other types of gut bacterial overgrowths, you may have to address them directly in order to indirectly save your other biomes.

As for the elements that can directly influence the reproductive tract biome, consider the following:

• Scented/bleached/deodorized feminine care products (think tampons, pads, feminine washes, scents, sprays, and douches). These toxic chemical laden products can do a doozy to your microbiome. Simply DO NOT USE THEM. Find organic period products, be they period panties, the Diva Cup, or organic cotton pads/tampons. Never douche or spray your genitals, just wash your vulva with chemical-free soap in the shower.

• Improper wiping techniques (back to front, instead of front to back) can introduce bacteria from your stool to your vagina. And, if you don’t get things clean enough (dare I say “skid marks”), the bacteria left on your panties can easily be introduced to your genital area.

• Not changing out of moist panties/bathing suits frequently enough can create an ecosystem ripe for dysbiosis, as anyone who spent the summer poolside only to get recurring yeast infections or UTIs knows too well. This also goes for cleaning up excess moisture after intimacy, working out, or even a hot day. Get thee many panties, and swap out whenever you feel like you could use a refresh.

For another simple but effective solution, you may also consider supplementing with a specific probiotic called Fem-Dophilus by Jarrow Research. 75% of women taking this probiotic saw significant improvement in vaginal flora composition. (2) Fem-Dolphilus may be taken orally or inserted vaginally if extra support is needed, something I actually recommend with many of my clients. One pill inserted vaginally for a month may be incredibly beneficial for restarting the health of your reproductive tract biome.

As you change these behaviors/products out, keep pH testing regularly to see if you’re making headway. Give it 2-3 months! Really, I mean it, try these little tips and see if you can make a dent in bringing that pH down. Chances are, by following these tips many of you will be able to see incredibly results in getting your pH down to a normal, healthy range.

Ok Miss SmartyPants, I followed your advice and my pH is still sky high. What next?

While I’m a BIG fan of the low hanging fruit approach (why spend money on testing when you just need to stop drinking so much beer or soda, for example), some of us will need further investigation. If you do the above for 2-3 months and feel nada mucho, please keep investigating. There are a few ways to do this:

1) Go to your gyno and test for endometritis, Pelvic Inflammatory Disease, and more

Endometritis is the infection of your uterine lining. Symptoms are similar to endo in many ways, including lower belly swelling/feelings of heaviness, abnormal discharge or bleeding, constipation or pain with bowel movements, and pelvic pain. Sound familiar?

Pelvic Inflammatory Disease (PID) is an infection of the upper reproductive tract and/or peritoneal fluid. It may be common for those with endo as well, since you’re 3x more likely to develop endometriosis in the first place if you have PID. (3) It too can cause pain, scarring, fertility problems, general feelings of sickness.

These are a bit more challenging to test for, but doctors can sleuth for these a few ways: samples, ultrasounds, or biopsies ( from what I’ve heard from clients around the U.S. the most common way seems to be a biopsy of the uterine lining… not exactly a fun procedure but hey, at least you’ll know). If you have endometritis or PID you can now clear it up with antibiotics and seriously help your body and endometriosis more than you could imagine! [As a side note, I only recommend antibiotics when it’s more life-or-death situations…they mess up the gut microbiome more than you know! In this case, if you have an infection of the endometrium or pelvis that’s not going away, take the antibiotics. Please. Get rid of that infection. Then go eat fermented foods.]

As long as you have symptoms + insurance, your test should be covered so you won’t pay much for this test, which is a bonus.

Your gyno can easily test for other issues as well, like yeast overgrowth or bacterial vaginosis (BV). My guess is that if you were diligent about following the advice from above (including the sugar/starch removal and probiotic insertion!) you won’t have these at this point. But if you do, both can be easily cleared up.

2) Test at home with a kit like Juno.Bio

While a test for endometritis or PID will uncover that one thing (like…do you have endometritis or PID), that’s all it will explore. And there are many other types of dysbiosis! Thankfully, for uncovering other issues there are some rad at-home options available. While they’re not covered by insurance, they are much more comprehensive in explaining the whole ecosystem of what’s happening, and offer guidance on what to do.

Recently one such test (Juno.Bio) reached out to me to give their test a whirl. Their test is seriously cool, like a comprehensive gut/stool test but for the vaginal microbiome. What I discovered is that it’s really, really easy, very indiscreet, and results are easy to understand.

To test you only do two things: test your pH with a handy pH testing wand, and swab your vagina with a Q-Tip and ship it back to the company for testing. That’s it! Now you upload a little information and wait for your results. In return, you will get the full results of your test, plus a 15 min consultation with a pro to talk about your finding and, if need, next steps to take. This is really handy because there are actually a lot of different ways reproductive tract dysbiosis can look like (check it here), and often very different ways to address it. This becomes even more handy for the chronic UTI, BV, or yeast infection ladies who can’t seem to “clear up” these issues (often because you’re not being treated for the right overgrowth!).

If you’re curious what results look like, 2.5 weeks later my own results were in (I was very excited because I’m a bacteria nerd, for which my poor husband is very supportive). This is what they looked like:

It was heartening to see, after years of research on just how much the reproductive tract microbiome can instigate endo-issues, that I am free of Southernly dysbiosis. It really makes sense, being that I’m 100% in clinical remission from endo, my ease in getting pregnant with baby #2, zero symptoms of pelvic pain like I used to, questionable discharge hasn’t made an appearance for years, and no more yeast infections or UTI (which used to be frequently occurring). In fact, knowing what I know now about normal discharge/flow/etc, I believe I probably had reproductive tract dysbiosis since I was young, affecting me for decades. My reproductive tract issues also began to dissipate around the same time my endo was fading into remission. So much hope in this for many of us!

Want to try? While I’m not affiliated with Juno.Bio and I don’t get commission on their products, I highly recommend them with a Heal Endo Two Thumbs Up. They also gave me THIS DISCOUNT CODE where you, dear reader, get $20 off. Go ahead, give yourself the gift of investigation.

Takeaway

My hope is that, through these last two posts, some of you start to uncover more root causes to your endo “mysteries”. Reproductive tract dysbiosis can look many different ways, from serious infections to low-grade overgrowths, and it may effect nearly all of us. Some of us may even suffer from it drastically, and many of us may be instead blaming our endo when it’s really issues here (in your reproductive tract) that are provoking everything. Really? Yes, for some of us. It’s okay though, because you can start to address it today.

Really… imagine if you have a serious case of endometritis causing that “endo belly” bloat, IBS symptoms, and pelvic pain, and then with a quick round of meds, you were clear. Or if painful sex was due to a pH so basic that your vaginal tissues were inflamed and atrophied, making penetration burn, sting, and be utterly awful—and that by saving your Southern microbiome you axed this symptom forever. What if your infertility journey went from bust to boom after getting rid of that huge pathogenic overgrowth?

Sounds cool, huh? I think so ;)

So if your pH testing wayyyyy out of range, seriously make it your mission to uncover why. Then address it. And when it’s addressed (and your pH is back to 4), send me an email and tell me how you feel. I’d honestly love to hear from you!

1 Khaleque Newaz Khan, Akira Fujishita, Michio Kitajima, Koichi Hiraki, Masahiro Nakashima, Hideaki Masuzaki. (2014). Intra-uterine microbial colonization and occurrence of endometritis in women with endometriosis. Human Reproduction. 29(11), 2446–56. https://doi.org/10.1093/humrep/deu222

2 Reid, G., Charbonneau, D., Erb, J., Kochanowski, B., Beuerman, D., Poehner, R., & Bruce, A. W. (2003). Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS immunology and medical microbiology, 35(2), 131–134. https://doi.org/10.1016/S0928-8244(02)00465-0

3 Tai, F. W., Chang, C. Y., Chiang, J. H., Lin, W. C., & Wan, L. (2018). Association of Pelvic Inflammatory Disease with Risk of Endometriosis: A Nationwide Cohort Study Involving 141,460 Individuals. Journal of clinical medicine, 7(11), 379. https://doi.org/10.3390/jcm7110379