Managing Recurrent Yeast Infections During Menopause

Recurrent yeast infections are a common issue during menopause due to hormonal changes. Understanding the causes and preventative measures can help manage this discomfort effectively.

What Are Recurrent Yeast Infections?

A yeast infection is typically caused by an overgrowth of Candida albicans, leading to symptoms such as itching, thick white discharge, redness, swelling, and urinary discomfort. While 75% of women will experience a yeast infection at some point, about 9% will suffer from recurrent infections, defined as having three to four infections per year.

Why Do Recurrent Yeast Infections Occur During Menopause?

The hormonal changes during menopause, including decreases in estrogen and testosterone, significantly affect the vaginal microbiome. Dr. Sameena Rahman explains that the reduction in these hormones can change the vaginal pH from acidic to basic, diminishing the protective lactobacillus bacteria and making vaginal tissue thinner and more prone to infections.

Additional Factors Contributing to Infections:

• Hormone Replacement Therapy (HRT): While beneficial for menopausal symptoms, HRT can increase the risk of yeast infections.

• Pregnancy and Birth Control Pills: Both can increase yeast infection rates due to estrogen's impact on yeast virulence.

• Antibiotics and Diabetes: Antibiotic use and uncontrolled diabetes are also known to increase the likelihood of yeast infections.

Preventative Measures

If you're experiencing recurrent yeast infections during menopause, consider these strategies to manage and prevent them:

1. Consider Vaginal Estrogen

   • Topical vaginal estrogen, available by prescription, can help restore the vaginal microbiome to a pre-menopausal state. This treatment is typically covered by insurance and helps balance hormone levels without significantly increasing the risk of infection.

2. Try Boric Acid Suppositories

   • Over-the-counter boric acid suppositories can be effective for recurrent infections, especially when standard treatments fail. They help break down biofilms that protect microorganisms, making it easier to eliminate the infection. Use one suppository daily for two weeks.

3. Ask About Antibiotics

   • For severe cases, a weekly dose of fluconazole (Diflucan) may be prescribed. This antifungal medication can be taken at 150 mg weekly for about 12 weeks, but should be used under a physician’s guidance.

   • A new medication, Vivjoa, approved in 2022 for post-menopausal women, may also be an option. It's designed for those with recurrent infections, particularly rare strains like Candida glabrata, though it may have insurance coverage limitations.

4. Avoid Irritants

   • Menopause makes vaginal tissue more sensitive, so avoid using scented hygiene products, harsh soaps, or douches that can irritate the area. Also, change out of wet or sweaty clothing promptly to prevent irritation and infection.

Conclusion

Managing recurrent yeast infections during menopause involves understanding the hormonal changes and taking proactive measures. From using vaginal estrogen and boric acid suppositories to avoiding irritants and seeking appropriate medical advice, women can effectively manage and prevent these uncomfortable infections. By staying informed and working with healthcare providers, it's possible to maintain vaginal health and overall well-being during menopause.