Coping With Vaginal Infections and Vaginal Atrophy After Menopause
So… You’re experiencing menopause. Now you have a high chance of developing vaginal atrophy (VA), a chronic condition that causes pain during sex and burning, itching, and other uncomfortable sensations in the vagina. It happens when women experience a decline in estrogen as they stop menstruating (or through other ways that estrogen runs out, like ovary removal or certain medications). And, it turns out, VA also increases your risk of developing urinary tract infections (UTIs) and vaginal infections like bacterial vaginosis (BV) and yeast infections. Fun, right? Here’s what you need to know about VA and these infections from two OB-GYNs.
How Does Menopause Increase Your Risk of Vaginal Infections?
Declining estrogen levels in menopause often change the pH balance of your vagina, says Shari Lawson, M.D., division director of general obstetrics and gynecology at Johns Hopkins Bayview Medical Center in Baltimore. Normal estrogen levels keep the vagina acidic, but menopausal women tend to have a more basic environment. “Certain bacteria thrive in more basic conditions, so there are some postmenopausal women who can be more prone to getting BV,” she says. Because menopause also increases the risk for urinary incontinence, Dr. Lawson sees more yeast infections in women who use pads for it, which can decrease oxygen flow.
Are Vaginal Infections More Common in Some Women?
If you have other chronic conditions in addition to VA, especially uncontrolled diabetes, you’re more likely to develop yeast infections, Dr. Lawson says, though this applies to women of any age, not just menopausal women. Another factor that can put you at increased risk for a yeast infection is taking antibiotics, like when you have a UTI, says Amy Park, M.D., section head of female pelvic medicine and reconstructive surgery at Cleveland Clinic in Cleveland, OH. “Sometimes people get into a cycle of getting recurrent UTIs, get them treated with antibiotics, and then they get yeast infections. I see that quite a bit,” she says.
How Can You Tell the Difference Between an Infection and Vaginal Atrophy?
Dr. Lawson says sometimes the symptoms of both conditions can be similar—vaginal irritation or itching, discomfort with sitting, burning after urinating, or pain with intercourse. “It’s really hard to self-diagnose an infection unless you’re someone who gets them recurrently,” she says. Dr. Park notes that if you’re using over-the-counter treatments for a yeast infection and they’re not working, you should definitely check in with your doctor. And if you have a foul-smelling discharge, Dr. Lawson says this is not associated with VA and could be BV, so this also warrants a doctor’s visit.
How Can You Tell the Difference Between a UTI and a Vaginal Infection?
With a UTI, you’ll likely have intense, burning pain when you urinate, and some people have blood in their urine or spasms in their bladder after urinating too, says Dr. Lawson. A UTI will likely leave you feeling so awful, you’ll be hurrying to your doctor for treatment, which is a good thing since the infection can spread to your kidney(s). For vaginal infections, Dr. Park says usually either your vagina or vulva is irritated and probably itchy, too. With BV, you’ll notice a bad-smelling discharge and with a yeast infection, it’ll be a thick, white, odorless discharge.
How Is a Vaginal Infection Treated vs. Vaginal Atrophy?
Yeast infections are treated with antifungals like fluconazole, a pill that’s only available by prescription, or creams, ointments, suppositories, and tablets like miconazole and terconazole, which are available over the counter and by prescription, says Dr. Park. Bacterial vaginosis is treated with metronidazole, which can be taken orally or as a vaginal gel; clindamycin, a vaginal cream; or oral tinidazole, all available by prescription. In contrast, VA is often treated with hormone therapy to replace the diminished estrogen that is leading to symptoms, lubricants and moisturizers to reduce vaginal dryness, and/or dilators to widen the vagina.
How Can I Reduce My Risk of Vaginal Infections With VA?
If you have diabetes, make sure it’s under control, since this puts you at a higher risk of both recurrent UTIs and yeast infections, says Dr. Park. She also advises staying away from harsh soaps and douching because you end up getting rid of both good and bad bacteria. Wear underwear with a cotton crotch and don’t use irritating or scented pads if you have urinary incontinence and VA, she says. Dr. Lawson adds that it’s good to avoid introducing water into your vagina during a shower or bath because this can also upset the balance of bacteria in the vagina.
What Happens if I Keep Getting Vaginal Infections?
There are suppression treatments your doctor can try if your infection keeps coming back, says Dr. Park. For BV, she says after the initial treatment, your doctor may have you use metronidazole gel one or two times a week for a while. For recurrent yeast infections, your doctor may prescribe you a weekly fluconazole pill for several months after your initial treatment. Dr. Lawson says that if you have recurrent yeast infections, you should ask to be tested for a type of yeast called Candida glabrata, which is resistant to the common antifungal treatments doctors use.
Can Probiotics Help Prevent Vaginal Infections and Treat VA?
At this point, research seems to indicate that probiotics help balance the vaginal environment, which may help prevent infections and treat VA. Dr. Lawson recommends that her patients eat plain Greek yogurt, drink kombucha, or take probiotic tablets at least three times a week. She notes also that using vaginal estrogen can help lessen your risk of BV and recurrent UTIs by balancing vaginal pH, so you may want to ask your doctor about options.
Are There Risks Associated with Leaving a Vaginal Infection Untreated?
“I think most of the risks are associated with discomfort and itching,” says Dr. Lawson. Excessive scratching can cause tears in your skin that could lead to a secondary skin infection too, a miserable experience, especially on top of VA. “It’s important to be evaluated if you’re having significant symptoms,” she says, adding that even simple itching may be a sign of something completely different than an infection, like early-stage skin cancer. Dr. Park says that leaving BV untreated may increase your risk of acquiring a sexually transmitted infection (STI) if you’re exposed to an infected sexual partner.
- VA Definition and Prevalence: Cleveland Clinic. (2020). “Vaginal Atrophy: Overview.” my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy
- VA and Vaginal Infections: Mayo Clinic. (2019). “Vaginal atrophy: Overview.” mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288
- Yeast Infection Treatments: Mayo Clinic. (2019). “Yeast infection (vaginal): Diagnosis & treatment.” mayoclinic.org/diseases-conditions/yeast-infection/diagnosis-treatment/drc-20379004
- BV Treatments: Mayo Clinic. (2019). “Bacterial vaginosis: Diagnosis & treatment.” mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285
- Probiotics and Vaginal Infections: Journal of Menopausal Medicine. (2017). “Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article.” ncbi.nlm.nih.gov/pmc/articles/PMC5770522/
- Probiotics and VA: Menopause. (2014). “Association Between the Vaginal Microbiota, Menopause Status and Signs of Vulvovaginal Atrophy.” ncbi.nlm.nih.gov/pmc/articles/PMC3994184/