Vaginal yeast infection and menopause
Oestrogen plays a crucial role in maintaining the natural balance of bacteria and fungi in the vagina. When oestrogen levels drop in the years leading up to menopause, the risk of vaginal yeast infections increases. How can you prevent and treat yeast infections?
I used to get yeast infections occasionally and medication always helped me really well. But now they’re so painful that I find it hard to sleep. - Melissa (age 51)
Approximately 75 percent of women will experience a vaginal yeast infection at some point in their lifetime. It's an annoying but common issue. During perimenopause your risk of vaginal yeast infection increases due to declining oestrogen levels and oestrogen dominance.
If you've ever had vaginal yeast infections, you know how frustrating they can be, especially if they keep coming back. It may be comforting to know that these infections are not common in postmenopausal women and tend to disappear a year after your last period. However, taking hormone replacement therapy (HRT) can increase your risk of getting a yeast infection.
What is happening in your body?
The vagina is a passageway that connects the vulva (the area between the legs that covers the opening to the vagina) to the cervix (opening of the uterus). If the balance between healthy bacteria and fungi in the vagina is disturbed, a yeast infection can occur.
Around the time of menopause, women can experience an increase in vaginal yeast infections. Sex hormones play an important role in promoting the growth of lactobacilli, a type of good bacteria found in the gut and mouth – and also in the vagina. In addition to fighting off infection, lactobacilli help keep your vaginal pH balanced and acidic (which also helps to prevent vaginal dryness). A healthy vagina has an acidic pH level that helps good bacteria to thrive.
During perimenopause, oestrogen and progesterone levels fluctuate and drop, which encourages the replication of bad bacteria and yeasts. Lower oestrogen levels also decrease vaginal acidity. This makes it more difficult for good bacteria to survive, allowing fungi and yeasts in the vagina to grow, including the fungus Candida albicans (the fungus responsible for most vaginal yeast infections). As a result, the healthy balance of bacteria is disrupted and the risk of infection increases.
Other causes
Other factors and/or menopausal symptoms can also play a role in vaginal yeast infections. For example, it has been shown that hormone therapy (vaginal oestrogen) and certain medications can increase the risk of getting a yeast infection. Ask your doctor if the medication you're taking can disrupt healthy vaginal flora.
Other risk factors for yeast infection include a weakened immune system, stress and fatigue (which also weakens your immune system), smoking, antibiotics use (e.g., for urinary tract infections, and, in turn, a yeast infection increases the risk for urinary tract infection) and type 2 diabetes (blood sugar spikes can cause yeast to overgrow in the vagina).
How do you know if you have a vaginal yeast infection?
The typical symptoms of a vaginal yeast infection include:
- Itching and/or burning sensation in the vagina and vulva
- Thick, white vaginal discharge with a cottage cheese appearance
- Redness and swelling of the vulva
- Pain during intercourse or while urinating
The symptoms of a vaginal yeast infection may resemble symptoms of vaginal dryness. Consult your GP to find out what is causing your symptoms and what the best way to treat them might be.
What can you do?
Yeast infections can be prevented by supporting your vaginal microbiome and restoring the balance of bacteria and fungi. Some tips:
- Take care of your gut. There is a close relationship between vaginal flora and intestinal flora. Research shows that the excessive growth of Candida in the vagina is highly associated with an overgrowth of Candida in the intestines. You can support your intestinal flora by eating fibre-rich foods (vegetables, fruit, whole grains, beans, nuts and seeds). Pack your diet with a rainbow of vegetables and fruits to get various vitamins and minerals, and drink plenty of water. Drinking water helps your body absorb nutrients and appears to be linked to increased diversity of bacteria in the gut.
- Supplement your diet with probiotics. A great deal of research has been done on probiotics. Although much remains to be learned about how probiotics work, they seem to promote gut health and stimulate the growth of good bacteria. Foods that are high in probiotics include yoghurt, kefir, sauerkraut, kimchi and kombucha (fermented products). You could also consider taking a supplement.
- Wear cotton underwear. By allowing air to circulate freely, breathable underwear helps maintain a dry and less hospitable environment for bacteria and fungi.
- Avoid irritants. Perfumed (and aggressive) products can irritate your vagina and disrupt your vagina's natural balance. Wash your vulva with a soft washcloth and lukewarm water rather than using soaps, washes or douches. The vagina is self-cleaning, so there’s no need to use these products.
Medication for vaginal yeast infections
If you think you might have a vaginal yeast infection, then an antifungal medicine can treat the infection and reduce your symptoms.
What treatments can help?
Sometimes, more support is needed to clear up a yeast infection. Vaginal tablets and creams are medicines inserted into the vagina to treat fungal infections. Hormone replacement therapy (HRT) can be used to treat women suffering from recurrent infections and multiple menopausal symptoms.
Non-hormonal medications for vaginal yeast infections
Diflucan is used to treat vaginal yeast infection caused by an overgrowth of the fungus Candida albicans in the vagina. Diflucan kills the fungus from the inside out and offers short-term relief from vaginal itching. Diflucan is taken orally. The active ingredient fluconazole stops fungi and yeasts from growing and multiplying. There are also other antifungal medicines available, including Nizoral (cream), Timodine (cream), and Itraconazole (capsules).
Can hormone therapy help?
If you are struggling with recurrent vaginal yeast infections, then an antifungal cream or tablet may not be the right option for you. You may want to consider hormone replacement therapy (HRT). HRT is a medical treatment that replaces some of the hormones lost during menopause and beyond. It is used treat severe menopausal symptoms, such as sleep problems and vaginal dryness. If you're experiencing other menopausal symptoms besides recurrent yeast infections, then HRT might be an option for you.
Sources
- Winsborough H, Baby DP. WebMD. (2023). How Menopause Can Lead to Recurring Vaginal Yeast Infections. https://www.webmd.com/menopause/menopause-vaginal-yeast-infections
- Mayo Clinic. (2022). Vagina: What's typical, what's not. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/vagina/art-20046562
- Mayo Clinic. (2023). Yeast infection (vaginal). https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999
- Pirotta MV, Garland SM. (2006). Genital Candida Species Detected in Samples from Women in Melbourne, Australia, before and after Treatment with Antibiotics. https://journals.asm.org/doi/10.1128/jcm.00218-06.
- Farr A, Effendy I, Frey Tirri B, Hof H, Mayser P, Petricevic L, Ruhnke M, Schaller M, Schaefer APA, Sustr V, Willinger B, Mendling W. (2021). Guideline: Vulvovaginal candidosis. PMID: 33529414.
- Lin XL, Li Z, Zuo XL. (2011). Study on the relationship between vaginal and intestinal candida in patients with vulvovaginal candidiasis. PMID: 22041440.
- National Center for Comlementary and Integrative Health. (2019). Probiotics: What You Need To Know. https://www.nccih.nih.gov/health/probiotics-usefulness-and-safety
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FAQ
I keep getting vaginal thrush. What can I do?
There are ways to prevent yeast infections from recurring. First of all, it’s important to adjust your lifestyle to restore the balance between fungi and bacteria in your vaginal microbiome. The scientifically proven recommendations on this page under 'What can you do?’ are a helpful starting point. Focus on eating healthy foods, probiotics and supporting your immune system. To clean your vulva, wash the external area with lukewarm water and avoid using soap or other vaginal products.
