While yeast infections after menopause are uncommon, some women may become more prone to vaginal yeast infections as they reach different stages of menopause.(1) Hormone levels start to fluctuate during perimenopause, continue to change throughout menopause, and remain at a new low in postmenopause. This causes changes to the vaginal flora ecosystem, potentially increasing the risk of yeast infections and leading to symptoms of vulvar irritation, pain, and itching.
Approximately 75% of women of reproductive age will experience a vaginal yeast infection during their lifetime.(2) Medically referred to as vulvovaginal candidiasis (VVC), yeast infections are one of the most common vaginal infections, responsible for 1.4 million outpatient clinic visits annually in the United States (U.S.).(2) Unlike urinary tract infections (UTIs), which are caused by a bacterial infection, yeast infections are a result of fungal overgrowth.
Understanding how hormonal fluctuations throughout menopause affect the vaginal flora can help women effectively manage and prevent yeast infections.
Causes of Yeast Infections from Perimenopause to Postmenopause
While menopause does not directly cause yeast infections, levels of estrogen that begin fluctuating in perimenopause and gradually decrease throughout menopause may be a contributing factor. Estrogen supports vaginal health by promoting healthy levels of Lactobacilli bacteria in the vagina. This “good” bacteria produces lactic acid and helps maintain a lower vaginal pH level, which protects against infection. As estrogen levels drop throughout the different stages of menopause, these hormonal changes cause a decrease in Lactobacilli bacteria and an increase in the vagina’s pH level, making some women more susceptible to yeast infections.(3)
Declining estrogen and progesterone levels during menopause can also cause thinning of the vaginal tissue, a loss of elasticity, and vaginal dryness, which can also increase the risk of yeast infections. These vulvovaginal changes persist as women reach postmenopause and hormones remain at a stable low. Research on yeast infection prevalence rates among postmenopausal women is lacking, but some studies suggest that between 3% and 7% of postmenopausal women who do not use hormone replacement therapy (HRT) may be affected by yeast infections.(3)(4)(5)
Some women who do use HRT may be more prone to yeast infections. While HRT does not directly cause yeast infections, it’s used to treat vaginal dryness — along with other common menopausal symptoms. As a result, natural vaginal lubrication can increase, and the added moisture in the vagina makes it a more hospitable environment for yeast.(2)(3)(6)
Genetics, stress, sexual activity, and the use of certain medications can also contribute to the development of yeast infections. Additionally, VVC has been linked with certain health issues, including diabetes and immunodeficiency. Some women may develop more of these risk factors as they age.
Recurring Yeast Infections in Menopause and Postmenopause
Menopause may influence the development of recurrent yeast infections. Women with recurrent VVC experience three or more symptomatic yeast infections in one year. While reports of prevalence rates vary, the condition is estimated to affect between 5% and 10% of women.(7)(8)
Yeast infections are classified as either uncomplicated or complicated VVC. Uncomplicated yeast infections are those with mild to moderate symptoms that occur occasionally in non-immunocompromised women. These cases are usually caused by Candida albicans fungus. In comparison, yeast infections that develop in women with compromised immunity, are present with severe symptoms, or are caused by non-albicans fungus are classified as complicated VVC. Recurrent yeast infections are also classified as complicated VVC cases.(3)(7)
While rare, recurrent yeast infections have been observed in postmenopausal women.(9) However, more research is needed regarding prevalence rates of recurrent VVC, specifically among perimenopausal, menopausal, and postmenopausal women.
Symptoms of Yeast Infections During Menopause
Menopausal women who develop VVC often experience many of the same symptoms as women in their reproductive years. The following are common symptoms of vaginal yeast infections:(2)
Pain in the genital area
Itching (which may seem worse at night due to fewer distractions)
Burning sensation
Redness
Abnormal vaginal discharge (thick, clumpy, watery, or white)
Pain during sex or urination for some
VVC isn’t the only type of yeast infection. Hormonal fluctuations can cause changes to the quantity and composition of saliva, which may increase the risk of yeast infections in the mouth among menopausal women. The condition is called oral candidiasis or oral thrush and can cause symptoms such as white patches in the mouth, loss of taste, or painful swallowing.(10)(11)
How to Treat Yeast Infections During Menopause
It’s important to consult a healthcare provider if symptoms of a yeast infection develop during menopause. A doctor can properly diagnose the condition and recommend appropriate treatment options, which may vary depending on whether it’s a case of uncomplicated or complicated VVC. It’s particularly crucial for pregnant women with a yeast infection to speak with their doctor, as some treatment options may pose serious health risks. It should be noted that it’s still possible for women to become pregnant during perimenopause.
The following are common vaginal yeast infection treatment recommendations:(2)(12)(13)
1. Topical Treatments
Topical azole antifungal creams are localized treatments applied inside the vagina. Many can be purchased over-the-counter (OTC). Treatment side effects may include itching or burning sensations.
2. Oral Medications
Fluconazole is an oral azole antifungal treatment. The medication is taken as a single dose, although a doctor may prescribe additional doses if symptoms do not improve. However, recurrence can occur even after treatment. The medication may produce side effects, such as stomach pain, nausea, headaches, or more potentially serious adverse effects. For some patients, oral medication may be prescribed jointly with topical treatment.
3. Vaginal Suppositories
Boric acid is a vaginal suppository that may be recommended as an alternative if the infection is resistant to azole antifungal treatment. It may also be recommended in addition to other medications. Some studies suggest that boric acid may be effective in treating recurrent vaginal yeast infections, but more research is needed on the benefits and risks of treatment. Boric acid suppositories are inserted into the vagina and should never be taken orally, as they can be toxic.
Lifestyle Tips to Prevent Yeast Infections During Menopause
Hormonal fluctuations and vaginal changes are a natural part of menopause. However, the following preventive strategies may help reduce the risk of vaginal yeast infections during this phase of life:(1)(3)(14)
1. Using Oral Probiotic Supplements
Clinical recommendations regarding probiotic use vary, and women should consult with their doctor before taking any supplements. Although probiotics are not a standard treatment method for yeast infections, research suggests they may play a role in prevention and treatment by replenishing Lactobacilli bacteria in the vagina and restoring a healthy vaginal pH balance.
2. Maintaining a Healthy Diet
Eating a healthy diet helps maintain overall health. Adding in foods that contain probiotics may further support the health of the vaginal flora. An early study found that eating 8 oz of probiotic-containing yogurt daily for six months reduced infection in women with recurrent yeast infections.(15)
3. Staying Properly Hydrated
Drinking enough water every day helps maintain vaginal health by keeping the vagina’s pH levels and balance of bacteria healthy. It’s recommended that women drink approximately 11.5 cups of fluid every day to stay hydrated.(16)
4. Wearing Cotton Underwear
Heat and moisture create an optimal environment for yeast infections. Cotton underwear is breathable and effectively absorbs excess moisture, reducing the risk of infection.
5. Practicing Good Personal Hygiene
Good personal hygiene is key in preventing yeast infections. Quickly changing out of wet clothes and regularly switching out used pads or tampons can help keep the genital area clean and dry. When using the bathroom, it’s important to always wipe from front to back to avoid exposing the vagina to bacteria.
6. Avoiding Douching
Cleaning the inside of the vagina with a stream of water or other fluids (douching) can disrupt the balance of bacteria in the vagina and increase the risk of infection. It’s recommended to wash the outside of the vagina with warm water and a gentle soap.
7. Using Fragrance-Free Products
Scented soaps and feminine hygiene products contain chemicals that can irritate the vagina and alter the vaginal flora. Using fragrance-free products can help maintain a healthy intravaginal environment.
It’s crucial that women receive professional treatment for vaginal yeast infections at the first signs of infection or recurrence. Seeking treatment early can prevent symptoms from worsening and reduce the risk of potential complications. Continuing to monitor for changes in vaginal health throughout perimenopause, menopause, and postmenopause is a key part of maintaining women’s overall physical health.
