Addressing Vaginal Yeast Infections During Menopause

If you are like most women, you have experienced a vaginal infection at some point in your life. The symptoms are all too familiar. Vaginal discharge, itching, irritation, odor, and painful sex can be hallmark. Common infections, like vaginal yeast infections or bacterial vaginosis, (BV) are no fun, and unfortunately, it’s possible for menopause to increase the risk of both.

We’ve covered the basics of bacterial vaginosis before, so here’s what you need to know regarding the main differences between BV and vaginal yeast infections, what the common symptoms of vaginal yeast infections are and what you can do to prevent them – particularly if you’re transitioning through menopause.  

Vaginal Yeast Infections vs. BV During Menopause

It might surprise you to learn that hormone changes can increase the risk for both vaginal yeast infections and bacterial vaginosis during menopause. In fact, variable estrogen levels during perimenopause and super low levels during menopause are often to blame for these specific vaginal infections.

Vaginal yeast infections are due to an overgrowth of fungus, while bacterial vaginosis is caused by an imbalance of bacteria. In general, a healthy vaginal pH is acidic, ranging from 3.8-4.5. Lactobacilli, a type of good bacteria, which naturally resides in the vagina, helps to maintain this pH along with supporting a healthy vaginal microbiome. Lactobacilli produce lactic acid to accomplish this. With the hormone changes experienced during menopause come less lactobacilli, resulting in pH alteration, and a greater risk for BV or vaginal yeast infections.

Symptoms of Vaginal Yeast Infections

It’s important to understand that there are specific differences between vaginal yeast infections and BV. As mentioned, BV is typically caused by an imbalance of bacteria in the vaginal microbiome. Vaginal yeast infections, on the other hand, are caused by an overgrowth of the fungus, candida. Candida is a naturally occurring fungus in the vagina, and beneficial lactobacillus bacteria normally would help to prevent too much of it from growing and causing an imbalance. But, when lactobacillus levels in the vaginal microbiome decline with lower estrogen levels during menopause, the vagina can become more susceptible to candida overgrowth.

This overgrowth of candida can cause the onset of disruptive vaginal yeast infection symptoms, including:

• Vaginal itching
• Thick or clumpy white vaginal discharge
• Swelling
• Burning or pain during sex
• Soreness
• Redness and a potential vulvar rash

What Can Increase the Risk of Vaginal Yeast Infections?

Yeast (and fungi) thrive in warm, moist, dark environments, so, it’s no wonder warmer temperatures are often primetime for vaginal yeast infections and irritation. Typical activities like swimming, sitting at the beach, and exercising outdoors can increase the risk for vaginal yeast infections, as women tend stay in damp, warm clothing for longer periods of time, creating the ideal environment for yeast to thrive. Some of the other common triggers of vaginal yeast infections can include:

• Increased dietary sugar or alcohol intake
• Wearing wet bathing suits or workout clothing for prolonged periods of time
• Wearing synthetic undergarment material, including ill-fitting thong underwear
• Having sex
• Hormones including the contraceptive pill

For women transitioning through menopause, a combination of hormonal shifts and the above activities seem to be a perfect recipe for vaginal yeast infections.

How to Prevent Vaginal Yeast Infections

There are several things you can do for vaginal yeast infection prevention. The following is recommended:

Take proactive steps. It’s common for women to leave wet or damp bathing suits or workout clothing on for too long, but this can create the perfect environment for yeast, especially when it’s warm out. Change out of your suit promptly after a swim to reduce your risk of a vaginal yeast infection and change out of damp workout clothes promptly after exercise. Also consider what you’re swimming in; chlorine from pool water or bacteria from lake and ocean water can disrupt your vaginal flora, so, be sure to take breaks from swimming to rinse off.

Consider investing in a good daily probiotic geared towards supporting vaginal health. This is different from the standard gut probiotic because of the beneficial bacterial strains a vaginal probiotic contains. Both the lactobacillus strain type and amounts are important when choosing the right probiotic in addition to the formulation, especially when you’re seeking to optimize vaginal colonization. For the science buffs and label readers out there, this would include lactobacilli strains of both acidophilus and rhamnoses, containing counts of at least 5 billion CFUs.

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Maintain a balance. Boric acid vaginal suppositories may help too for the prevention of vaginal yeast infections. The word “acid” sounds scary, yes, but this preventive measure has been available for years and is gaining mainstream popularity.  Boric acid vaginal inserts, used cyclically or episodically, can help to acidify the vagina to maintain a normal pH and lessen the risk of infection. One caveat; boric acid is never to be orally ingested. Be sure to check with your healthcare provider before incorporating boric acid or any new over-the-counter treatments into your routine.

Modify diet choices. Be mindful of your diet, specifically, your sugar and alcohol intake. Ensure you’re getting adequate amounts of vitamin D too: it’s essential for maintaining normal immune function and may help stave off infections.

Sex matters. It is vital to manage vaginal dryness and painful sex, which can result from low estrogen levels during menopause. Dryness can lead to tiny micro abrasions during sex and might increase risk of certain infections, including STIs. Regular use of vaginal moisturizers, such as Revaree®, or a minimally absorbed vaginal estrogen if appropriate, are helpful to address dryness.

Consider condoms. If you’re prone to BV or yeast infections or have multiple sexual partners, regular condom use can play a role in prevention of these types of infections. Semen can alter the vagina’s natural pH, making you more susceptible to infections. Coupled with the hormonal changes experienced during menopause, it may make sense to use condoms to mitigate the risk of altering your vaginal pH, since ejaculate is alkaline. This may also potentially reduce the risk of developing a vaginal yeast infection or BV.

Ditch the scented soaps. Hypoallergenic, fragrance-free, and dye-free products are favored for use on delicate, intimate skin. This might include body washes, soaps, wipes, and menstrual hygiene products. Douching is discouraged. Keep in mind, not all vaginal symptoms are due to infection, but occasionally they are due to external irritants. Chlorinated pools and hot tubs are often an inciting factor in addition to highly scented products. Avoidance of these potential irritants may be needed, at least temporarily, until symptoms resolve.

When Should a Women Seek Medical Attention?

Infections such as BV or vaginal yeast infections, whether experienced before, after, or during menopause, are often managed with over-the-counter treatments and common-sense interventions. Persistent, recurrent, or worsening symptoms of infection should be addressed by a healthcare professional. 

Certain vaginal infections are common, particularly during menopause. Being proactive to prevent and manage intimate care can be the key to staying comfortable and infection-free!