How MetroGel for BV and Rosacea Is Used (and Side Effects to Know)

Between your nightly skin care, your hair products, and your prescriptions, your medicine cabinet is probably stocked with creams, lotions, gels, and more. So if you’ve recently found yourself with a prescription for MetroGel, you might be wondering where this new one fits in. And to make things even more confusing, MetroGel can treat very different conditions and symptoms.

MetroGel is a brand name for a topical prescription antibacterial medication called metronidazole. Different formulations are used to treat different concerns: 

• A 0.75% metronidazole vaginal gel is a first-line treatment for bacterial vaginosis (BV), an overgrowth of bacteria that causes grayish vaginal discharge, a fishy odor, and irritation. 
• There’s also MetroGel for rosacea, a 1% gel. Rosacea is a skin condition involving redness, pimples, and broken blood vessels on the face, neck, and chest. It often causes thickening of the skin.

Both of these conditions are more common in midlife, so you might be introduced to them (and MetroGel) for the first time in your 40s or 50s. As estrogen gradually declines, the balance of protective bacteria in the vagina changes, which can leave you more vulnerable to BV. Rosacea is also more common in menopause, although researchers aren’t sure why.

Both metronidazole gel for BV and for rosacea are available only with a prescription. Your prescribing clinician will explain to you how you should use it. But for general information about how each formulation is used, keep reading.

What Is MetroGel, and What Does It Treat?

MetroGel is a brand-name prescription antibiotic. The generic medication is called metronidazole, and it also has antimicrobial and anti-inflammatory effects.

The FDA has approved metronidazole gel for two uses:

• a 0.75% strength vaginal gel for BV
• a 1% strength topical gel for the bumps and redness of rosacea

In either case, metronidazole gel is applied locally rather than taken orally. For BV, there is an oral metronidazole option if you prefer taking a pill—just know that gastrointestinal (GI) side effects are less common when using the gel form.

MetroGel is a prescription-only medication in the United States. You’ll need a clinician’s assessment and diagnosis before you can get a prescription for metronidazole to treat BV or rosacea. Keep in mind it doesn’t treat other vaginal infections, such as yeast infections or urinary tract infections, so you shouldn’t use any leftover prescription gel for other symptoms.

MetroGel Vaginal vs. MetroGel Topical: What's the Difference?

One thing to be clear on: The two different types of MetroGel aren’t interchangeable. The 1% facial gel is not designed for vaginal use, and the 0.75% vaginal gel is not a rosacea treatment.

To help you tell them apart, the packaging differs. The vaginal formulation comes with applicators to deliver the gel into your vagina. The topical formulation is meant to be rubbed directly onto your skin in a thin layer. Your clinician will tell you whether you should apply it once or twice per day and whether you need to apply it for a few weeks or up to 2 months.

You can always check the labels and prescription instructions if you need some reassurance about how to use MetroGel. But if anything on the label is unclear, contact your clinician or your pharmacist rather than guessing.

You might also see different brand names for these gels, including:

• MetroGel
• MetroCream
• MetroLotion
• Noritate Cream
• Vandazole
• metronidazole gel or cream (this is the generic)

How Does MetroGel Work for Bacterial Vaginosis?

BV is an imbalance or overgrowth of certain bacteria in your vaginal microbiome, or the community of bacteria that live in your vagina. Typically, you have more Lactobacillus bacteria there, which produce lactic acid. With BV, though, you have higher concentrations of anaerobic bacteria—most notably Gardnerella vaginalis, along with species like Prevotella and Mobiluncus.

BV isn’t an infection you “catch” somewhere, and it’s not considered sexually transmitted, although sex can increase your risk of the anaerobic bacteria growing.

Most people don’t experience any symptoms of BV. But when they do, they typically notice:

• thin, gray or white vaginal discharge
• a fishy odor, particularly after sex
• burning when peeing

If you have BV symptoms, treatment can include:

• metronidazole gel
• oral metronidazole
• clindamycin cream

Metronidazole specifically targets those anaerobic bacteria driving the imbalance in your vaginal microbiome, allowing your normal vaginal bacteria to come back strong. (While oral metronidazole is also highly effective, many people prefer the vaginal gel because possible GI side effects, like nausea, are less common with the gel.)

Your symptoms may start to go away during the course of your treatment, but you should take all the medication your clinician prescribes to make sure your vaginal microbiome is restored. 

Still, BV can come back, and it frequently does. In fact, as many as two-thirds of women will have BV again in the year after their first experience. If you have it 3 or more times within a year, it’s classified as recurrent BV.

A healthcare professional (such as a Midi clinician) can recommend measures to help keep your vaginal microbiome healthy and help prevent future infections, such as using a pH-balanced vaginal moisturizer.

Why Is Bacterial Vaginosis More Common in Perimenopause and Menopause?

BV is more common in midlife, mainly because estrogen declines during perimenopause and in menopause. And lower levels of estrogen disrupt the vaginal microbiome.

Here’s why: Typically, when you have plenty of estrogen, the lining of the vagina produces glycogen, a form of sugar, which feeds the “good” Lactobacillus bacteria in your vaginal microbiome. But you naturally produce less glycogen there when estrogen levels drop. This causes a subsequent drop in Lactobacillus bacteria because they don’t get enough to eat.

These bacteria, when healthy and plentiful, produce lactic acid. But when you don’t have as many of them in your vaginal microbiome, there isn’t as much acid, meaning your vaginal pH starts to rise. This higher vaginal pH is less protective and is a more welcoming environment for the type of bacterial overgrowth that causes BV and other concerns.

Decreasing estrogen levels also result in thinner, drier vaginal tissue, which can lead to more irritation, pain during sex, and urinary issues. These symptoms together are called genitourinary syndrome of menopause (GSM), and it can set you up for recurrent infections.

But just because BV is more common in midlife doesn’t mean you should suffer in silence. Talk with a healthcare professional, such as a Midi clinician, about any pattern you notice in BV symptoms after age 40. It could be hormone-related, which means vaginal estrogen or other supportive approaches (alongside antibiotic treatment when needed) may help.

How Do You Use Metronidazole Vaginal Gel Correctly?

Your prescribing clinician or pharmacist will direct you on how to use metronidazole vaginal gel. Your course length and dosing schedule may vary, depending on which product you’re prescribed.

Generally speaking, the process for using metronidazole vaginal gel 0.75% is as follows:

First, fill the applicator:

• Remove the cap and use the pointed tip of the cap to puncture the metal seal on the tube.
• Screw the end of the applicator onto the tube.
• Slowly squeeze the gel into the applicator until the plunger stops.
• Unscrew the applicator and replace the cap on the tube.

Then, insert the applicator:

• While lying down on your back (or in any comfortable position), insert the barrel of the applicator into your vagina as far as you comfortably can.
• Slowly press the plunger until it stops, then carefully withdraw the applicator.

If you’re using vaginal metronidazole once per day only, your clinician will typically recommend doing so at bedtime. That’s because lying down helps the gel stay in place. You might experience some of the gel leaking out or some changes in vaginal discharge during the day. Consider wearing a panty liner or pad if this happens, but skip tampons, which you should avoid while you’re using metronidazole gel. 

Even if you start to feel better after a couple days, make sure to use the gel for as long as your clinician prescribes. Otherwise, you might not fully address the bacterial imbalance of your vaginal microbiome, and your symptoms could come back. You should keep using vaginal metronidazole if you get your period during treatment, too.

How Is MetroGel Used for Rosacea?

You use the 1% topical MetroGel for rosacea a bit differently. After cleansing and drying your face, apply and rub in a thin layer of the gel anywhere you have affected skin. Metronidazole for rosacea is typically applied just once per day. You can apply any of your usual face lotion, SPF, or makeup after the gel dries.

Typically, metronidazole can help reduce puffiness, redness, and the number of rosacea blemishes you have. You might start to notice results in a couple of weeks, but your clinician might recommend giving it 6 to 8 weeks to really take effect.

Some people with rosacea have visible blood vessels. These are hard to reduce with any topical treatment and instead usually require laser treatment.

Technically, there’s no cure for rosacea. Instead, it’s all about managing your skin and preventing flares. That might require ongoing maintenance therapy with a variety of over-the-counter and prescription lotions, creams, or gels.

Perimenopause can make rosacea flares worse (hot flashes and skin flushing certainly don’t help). A healthcare professional, such as a Midi clinician, can help you get to a maintenance routine that keeps your skin as happy as possible. 

What Are the Side Effects of Metronidazole Gel?

MetroGel might be sounding pretty impressive by now, and it certainly can be for many women. But, as with any medical treatment, it’s possible to experience some side effects. You might not notice any of the below, and you should always talk with your prescribing clinician about what you can expect. But in general, these are the most common metronidazole gel side effects.

Vaginal gel side effects

• a metallic taste in your mouth
• nausea
• vaginal irritation or itching
• cramping or abdominal pain
• headache
• a fungal infection (yeast infections can sometimes follow antibiotic treatment for BV or other bacterial infections because of the way the balance of vaginal bacteria changes; if you notice a thick, white discharge that looks like cottage cheese, you may have a yeast infection)

Topical gel side effects

• contact dermatitis, or stinging, burning, dryness, redness, or other irritation where you apply the gel
• eye irritation or tearing if you get some in your eyes
• colds or other respiratory infections
• headaches

Contact a clinician if you’re using any kind of metronidazole and notice the following:

• new numbness or tingling in your hands or feet
• signs of an allergic reaction, such as hives or swelling of your face, mouth, or throat
• severe irritation
• dizziness or loss of balance
• unusual vaginal discharge, itching, or odor
• sudden eye pain or vision changes

What Should You Avoid While Using MetroGel?

Your clinician might recommend that you avoid drinking alcohol while using MetroGel and for 24 hours after your last dose. This is one of the big metronidazole gel precautions, because a reaction with alcohol is possible in people who take oral metronidazole. This reaction can cause symptoms like sweating, thirst, headache, nausea, and vomiting that lasts from 30 minutes to several hours. 

That said, you’ll have significantly lower levels of metronidazole in your blood from a gel formulation, so the likelihood of a severe reaction between alcohol and metronidazole is low. Still, follow any instructions about avoiding alcohol from your clinician and on the label of your MetroGel. (And if you have rosacea, consider that alcohol can act as a trigger and make the condition worse.)

While using vaginal metronidazole, you should also avoid having vaginal sex or using tampons. While using topical metronidazole, avoid contact with your eyes.

Both metronidazole gel for BV and for rosacea come with a caution for anyone taking the blood thinner warfarin. Oral metronidazole may make the effects of this blood thinner stronger. Oral metronidazole may also interact with lithium. 

While the chances of having an adverse reaction to the gel form are much lower, it’s still a good idea to share your full medication list with your prescribing clinician. They can review these and any other potential safety concerns before you start metronidazole.

How Long Does MetroGel Take to Work, and What if Symptoms Return?

If you’ve been prescribed MetroGel, you’re probably eager to know: How long does metronidazole gel take to work?

For BV, symptoms such as odor and discharge can start to clear up within the first few days of treatment (although you should still finish your entire course of medication). For rosacea, it often takes several weeks until you notice improvements.

Rosacea is a long-term condition you have to manage, and BV can come back—called recurrent BV—so if you don’t notice improvements or if your symptoms come back, it doesn’t mean you did anything wrong. For example, even though around 80% of BV cases go away after treatment, around 60% of people go through it again within the next year.

A clinician might want you to use metronidazole for a couple months for rosacea. And they might try a longer course, different medication, or further evaluation for recurrent BV.

If your BV symptoms don’t go away or if they return within a month of treatment, you’ll need to seek in-person care for a physical evaluation and culture.

When Should You Talk With a Clinician About MetroGel?

If your BV or rosacea symptoms don’t improve or return quickly after treatment, talk with a clinician. It’s possible these are related to perimenopause, and holistic midlife care may be a better approach.

In a full evaluation, clinicians, including Midi clinicians, can go over your symptom history, medical history, and treatment options—not just for BV or rosacea but also for other common experiences during this chapter of life, such as vaginal dryness, irritation, and painful sex. 

Midi’s menopause-trained clinicians are sensitive to these experiences and can help you find a treatment approach (like an estrogen cream or patch) that works for you. Book a visit today.

Key Takeaways

• MetroGel is a brand-name prescription antibiotic gel. The active ingredient, called metronidazole, can be used for bacterial vaginosis and rosacea.
• Both rosacea and BV are more common in midlife. If you also experience other symptoms of perimenopause or menopause, it’s worth a larger discussion with a clinician, as you may be a candidate for other therapies that can help.
• The gel has fewer side effects and adverse reactions than an oral version of metronidazole, although that can also be an effective antimicrobial treatment.
• Always follow the instructions on the label of your MetroGel, along with any instructions provided by your prescribing clinician. Seek care for any symptoms that don’t go away or return quickly after treatment.

Frequently Asked Questions (FAQs)

Is MetroGel the same as Flagyl?

Not exactly. MetroGel and Flagyl both have the same generic active ingredient, metronidazole. But MetroGel is the brand-name of a gel specifically formulated for BV and rosacea. Flagyl is the brand-name of an oral pill that can be used to treat BV as well as trichomoniasis and other reproductive and digestive system infections.

What should you avoid while using MetroGel?

You should avoid drinking alcohol during your treatment and for 24 hours after your last dose. You should also avoid using tampons or douches and having vaginal sex while using vaginal metronidazole. You should avoid getting topical metronidazole for your face in or near your eyes.

Can MetroGel cause a yeast infection?

It’s possible. Antibiotics—including metronidazole—may change the bacterial balance of your vaginal microbiome. When this balance is off, yeast can overgrow, leading to a yeast infection. Talk with your clinician if you notice a cottage cheese–like vaginal discharge during or after treatment with MetroGel.

Can you get metronidazole gel over the counter?

No, metronidazole gel is available only with a prescription from a clinician.

Can you use metronidazole vaginal gel during your period?

Yes, you can use metronidazole vaginally while menstruating. And if you get your period while already using it, keep using it as directed.