Beyond the Gut: How Pro-, Pre-, and Postbiotics Support Women's Health - International Probiotics Association
By Gayathri Balakrishnan, (PhD), Lead Science Director at USPL Nutritionals (Biofarma Group) Introduction Women’s health is shaped not just by the gut microbiome but also by the distinct vaginal microbial ecosystem, ideally dominated by Lactobacillus species. These lactobacilli help maintain a pH below 4. 5, suppressing the growth of opportunistic pathogens. The vaginal microbiota is dynamic, […]
, (PhD), Lead Science Director at USPL Nutritionals (Biofarma Group)IntroductionWomen’s health is shaped not just by the gut microbiome but also by the distinct vaginal microbial ecosystem, ideally dominated byLactobacillusspecies. These lactobacilli help maintain a pH below 4. 5, suppressing the growth of opportunistic pathogens. The vaginal microbiota is dynamic, shifting throughout a woman’s life – from puberty to menopause and during pregnancy [1]. A healthy microbiome is characterized by dominance ofLactobacillusspecies such asL. crispatus,L. gasseri,L. iners, andL. jensenii. When this balance is lost, lactobacilli are displaced by anaerobes such asGardnerella,Streptococcus,Prevotella, andMegasphaera[2]. This dysbiotic state increases the risk of vaginal inflammation and infections such as bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) [3]. Pro-, pre-, and postbiotics have gained attention as strategies for vaginal dysbiosis by restoring the microbial balance toward equilibrium. ProbioticsSeveralLactobacillusspecies have been studied as probiotics for vaginal health. Their mechanisms include supporting the recovery of the vaginal microbiota, reducing pH through lactic acid production, secreting bacteriocins and hydrogen peroxide, and disrupting the biofilms that shield pathogenic organisms [4]. Beyond increasing beneficial bacteria, recent randomized trials have shown thatLactobacillusinterventions used as co-treatment with antibiotics reduced recurrence of vaginal infections, lowered inflammatory markers IL-1β and IL-6, and improved vaginal health indices [5–7]. PrebioticsPrebiotics selectively foster endogenous lactobacilli already resident in the vagina, favoring their expansion over pathogens and reinforcing balance from within rather than introducing exogenous strains. In vitrostudies show that short-chain fructo-oligosaccharides, gluco-oligosaccharides, and lactulose selectively stimulateL. crispatus,L. jensenii, andL. vaginalis, boosting their lactic acid output while failing to support BV associated anaerobes [8,9]. While preliminary evidence is promising, the principal limitation is the availability of dedicated large-scale trials. Since much of the supporting data is preclinical, prebiotics are best positioned as a complement to live strains rather than being a standalone option at present. PostbioticsPostbiotics are the metabolites and/or structural components of beneficial microbes that mediate their protective effects. A recent clinical study using a postbiotic gel showed reduced vaginalGardnerellaspp. in women with BV [10]. A bacteriocin-containing protein fraction (< 3 kDa) from the cell-free supernatant ofL. paracaseiCH88 inhibited growth and biofilm formation ofG. vaginalisin vitro and reduced pro-inflammatory cytokines in a murine model, with activity stable across a wide range of temperature and pH, suggesting preliminary potential for ameliorating BV. As with prebiotics, most postbiotic evidence remains preclinical, but the heat- and storage-stability of these compounds makes them an attractive, well-tolerated option for developing dietary supplements [11]. ConclusionThe vaginal microbiome is a key determinant of women’s health, and its disruption drives common, recurrent bacterial and yeast infections. Pro-, pre-, and postbiotics act through distinct but complementary mechanisms that replenish beneficial bacteria, nourish those already present, and supply their protective metabolites. While larger trials are needed to standardize strains, doses, and delivery routes, current evidence supports these biotics as promising additional therapies to standard antibiotic treatment. About the author:Gayathri Balakrishnan, Ph. D. , is a food scientist with over a decade of experience in product development across the food and dietary supplement industries. She holds a Ph. D. and M. S. in Food Science from the University of Florida and a B. S. in Food Technology from Anna University, India. She has authored numerous scientific publications and is a co-inventor of a U. S. patent for cranberry-based meat alternative compositions. Gayathri currently serves as Lead Science Director at USPL Nutritionals LLC (Biofarma Group), where she drives new product innovation in the nutraceutical and probiotic supplement categories. In this role, she evaluates novel ingredients, assesses clinical and preclinical evidence to substantiate product claims, and serves as a scientific liaison, bridging research and industry for various customers. References:Smith, S. B. and Ravel, J. , 2017. The vaginal microbiota, host defence and reproductive physiology. The Journal of physiology,595(2), pp. 451-463. Amabebe, E. and Anumba, D. O. , 2018. The vaginal microenvironment: the physiologic role of lactobacilli. Frontiers in medicine,5, p. 389042. Valeriano, V. D. , Lahtinen, E. , Hwang, I. C. , Zhang, Y. , Du, J. and Schuppe-Koistinen, I. , 2024. Vaginal dysbiosis and the potential of vaginal microbiome-directed therapeutics. Frontiers in Microbiomes,3, p. 1363089. Borrego-Ruiz, A. and Borrego, J. J. , 2025. Microbial pathogens linked to vaginal microbiome dysbiosis and therapeutic tools for their treatment. Acta Microbiologica Hellenica,70(2), p. 19. Heczko, P. B. , Tomusiak, A. , Adamski, P. , Jakimiuk, A. J. , Stefański, G. , Mikołajczyk-Cichońska, A. , Suda-Szczurek, M. and Strus, M. , 2015. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Women’s Health,15(1), p. 115. Russo, R. , Superti, F. , Karadja, E. and De Seta, F. , 2019. Randomised clinical trial in women with Recurrent Vulvovaginal Candidiasis: Efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses,62(4), pp. 328-335. Bohbot, J. M. , Daraï, E. , Bretelle, F. , Brami, G. , Daniel, C. and Cardot, J. M. , 2018. Efficacy and safety of vaginally administered lyophilized Lactobacillus crispatus IP 174178 in the prevention of bacterial vaginosis recurrence. Journal of gynecology obstetrics and human reproduction,47(2), pp. 81-86. Rousseau, V. , Lepargneur, J. P. , Roques, C. , Remaud-Simeon, M. and Paul, F. , 2005. Prebiotic effects of oligosaccharides on selected vaginal lactobacilli and pathogenic microorganisms. Anaerobe,11(3), pp. 145-153. Collins, S. L. , McMillan, A. , Seney, S. , van der Veer, C. , Kort, R. , Sumarah, M. W. and Reid, G. , 2018. Promising prebiotic candidate established by evaluation of lactitol, lactulose, raffinose, and oligofructose for maintenance of a lactobacillus-dominated vaginal microbiota. Applied and environmental microbiology,84(5), pp. e02200-17. Shen, X. , Xu, L. , Zhang, Z. , Yang, Y. , Li, P. , Ma, T. , Guo, S. , Kwok, L. Y. and Sun, Z. , 2023. Postbiotic gel relieves clinical symptoms of bacterial vaginitis by regulating the vaginal microbiota. Frontiers in Cellular and Infection Microbiology,13, p. 1114364. Moon, E. C. , Park, M. S. , Lim, T. , Kim, R. H. , Ji, G. E. , Kim, S. Y. and Hwang, K. T. , 2022. Antibacterial effect of cell-free supernatant fraction from Lactobacillus paracasei CH88 against Gardnerella vaginalis. Scientific Reports,12(1), p. 4763.