Gynoflor Review: Efficacy & Safety Explained

Gynoflor is a prescription-only vaginal medication that contains freeze-dried Lactobacillus acidophilus and a small amount of an oestrogen, oestriol (E3).

Gynoflor is used as a supportive treatment of atrophic vaginitis and repopulation after pharmaceutical treatment of yeast infections, bacterial vaginosis (BV), trichomoniasis, and other vaginal infections.

Gynoflor is only available in certain countries.

Dose of Gynoflor

The recommended dose is 1-2 tablets inserted deep into the vagina at night before bed as prescribed by your practitioner, with treatment periods ranging from 6-12 days, stopping during menstrual bleeding, then continuing afterwards.

Studies showed that once inserted, the tablets disintegrate quickly, and the bacteria ‘come back to life’ within a couple of hours.

Those who shouldn’t use Gynoflor

Children and girls who do not yet have their first period are not to take Gynoflor
Hypersensitivity to oestriol (E3) or any of the other constituents of Gynoflor
Actual or suspected endometriosis
Hormone-dependent tumour of the breast, uterus or vagina (read about atrophic vaginitis after breast/hormone-dependent cancer)
Raw, inflamed or painful vaginitis
Bleeding of unknown origin

Strengths and weaknesses of Gynoflor

What Gynoflor has that makes it more useful than inserting single-strain probiotic capsules is oestriol (E3), which while not impacting blood levels of the more prominent E1 and E2 oestrogens (which can be dangerous), E3 stimulates the vaginal, cervical and vulvar cells so they are active, and produce glycogen, a form of sugar used as a food source for growing friendly lactobacilli.

This means that the L. acidophilus can proliferate, excreting lactic acid and hydrogen peroxide to help encourage the growth of other friendly lactobacilli by changing the pH (to more acidic) and inhibiting the growth of other bacteria using the various ways and wiles these bacteria have at their disposal.

Stimulating the vaginal cells may be quite useful for women with atrophic vaginitis, since this is most often caused by menopause or near-menopause lowering of oestrogen throughout the body. This causes cells to ‘dry up’, including vaginal cells, leaving many menopausal women with dry, easily-torn vulvar tissue and vaginas. Gynoflor, among many other oestrogenic options, provides the fodder (oestriol) the vagina needs to stimulate itself back to its juicy self.

Benefits of Gynoflor

Low-dose, short-acting hormonal impact
Includes healthy lactobacilli to help recolonise the vagina
Pills contain lactose, a food source for lactobacilli
E3 is not dangerous for cancers and the treatment barely introduces any oestrogen into the bloodstream, and when it does, it’s a small amount that is quickly metabolised and excreted

What Gynoflor won’t do

Gynoflor is not used as a standalone treatment for recurrent vaginal infections like BV.
If you have recurrent BV, Gynoflor will likely not remove the biofilm that remains in place without extra efforts (but, it may and is worth trying if offered to you by your doctor).
The lactobacilli inside Gynoflor are very limited in species and action, so it is advisable to take an oral probiotic and eat and drink fermented foods and drinks regularly.
Gynoflor will not cause proliferation of the endometrium (which can cause major problems with cancers and endometrial hyperplasia).
Gynoflor is not going to be very useful in treating oestrogen deficiency problems, since it is barely absorbed into the blood.
Over the course of treatment, E3 levels did not rise.

Ingredients of Gynoflor

Oestriol (E3) 0.03 mg
At least 10 million viable freeze-dried Lactobacillus acidophilus
‘Lactose and other excipients’

The type of oestrogen in Gynoflor, E3

E3 is a weak oestrogen usually only present in any significant amounts during pregnancy. It is in ongoing trials and being used as a treatment for genitourinary symptoms of menopause (GSM) and some oestrogen-dependent cancer treatments.¹

E3 has also proven to be useful in managing multiple sclerosis (MS) symptoms in some people.²

E3 has been successfully used as a repopulation tool post-treatment of bacterial vaginosis, yeast infections, trichomoniasis, and other vaginal infections.³

Gynoflor for recolonisation – does it work?

Gynoflor was tested as a management tool for post-antibiotic or anti-fungal treatments for bacterial vaginosis, yeast infections and trichomoniasis, and was reasonably successful at least in the short-term. Gynoflor is manufactured by Medinova.

Relapse rates are variable for each of these conditions separately, and it doesn’t make sense to compare them all at once. However, since the study was not specifically looking at relapse rates, but the restoration of normal vaginal flora after antibiotic treatment, these findings are not well defined, and are grouped together.

The relapse rates are only calculated within six weeks, but other studies work on longer time-frames – three months is ideal, since it allows the vaginal microflora to recover as much as it is going to (in the short term) after antibiotics or other treatments, to determine efficacy.

Short-term treatments may seem to help immediately, but if the core problem is not resolved – dependent on the condition – then success is far from guaranteed.

What’s more, while treating yeast infections with antifungal drugs during the trial, researchers discovered at least 50 per cent of those taking metronidazole (an antibiotic) developed a post-antibiotic yeast infection. This is so common to be thought of as ‘normal’, however antibiotic-induced yeast infections remain a huge problem for many and are a possible deterrent to further antibiotic treatment.

The relapse rates in this particular study were reported at just under eight per cent for all women, but the breakdown of these numbers needs examining in further detail, since the conditions treated all have different causes.

For example, yeast infections may be exacerbated by high oestrogen; BV may be exacerbated by low oestrogen; and trichomoniasis is a sexually transmitted infection that, after successful antibiotic treatment, relapse is impossible unless the person is reinfected by a sexual partner.

The relapse rates in this study are therefore of very little use to us, and in terms of the treatment value of Gynoflor, it is – as with most things – worth a try depending on your circumstances, combined with other recolonisation efforts such as an appropriate vaginal probiotic.

Gynoflor is reported by the manufacturer to be safe to use during pregnancy, breastfeeding and lactation.

Side-effects of Gynoflor

Side effects were uncommon in clinical trials, however included:

General vaginal irritation
Burning, itching, redness
Allergic reaction

Gynoflor does not contain toxic ingredients, and those ingredients it does contain have been deemed safe at least for the duration of the treatment period.

References^4,5

1.
Donders G, Neven P, Moegele M, et al. Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor®) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. Breast Cancer Res Treat. Published online April 10, 2014:371-379. doi:10.1007/s10549-014-2930-x
2.
Sicotte NL, Liva SM, Klutch R, et al. Treatment of multiple sclerosis with the pregnancy hormone estriol. Annals of Neurology. Published online August 19, 2002:421-428. doi:10.1002/ana.10301
3.
Ozkinay E, Terek MC, Yayci M, Kaiser R, Grob P, Tuncay G. The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections. BJOG. Published online January 14, 2005:234-240. doi:10.1111/j.1471-0528.2004.00329.x
4.
Donders G, Bellen G, Neven P, et al. Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors. Eur J Clin Microbiol Infect Dis. Published online July 30, 2015:2023-2028. doi:10.1007/s10096-015-2447-1
5.
Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. Published online September 30, 2010:509-522. doi:10.3109/13697137.2010.522875