Skip to main content

Advertisement

SpringerLink
Log in

Vulvovaginal Candidiasis in Postmenopausal Women

  • Female Genital Tract Infections (JD Sobel, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Vulvovaginal candidiasis (VVC) is one of the most common vaginal infections worldwide, but limited evidence-based data is available on postmenopausal women who develop this infection. As women transition through menopause, the effects of decreasing endogenous estrogen production on the vaginal environment have a significant impact on VVC infections in these women. In this review, we discuss the protective mechanism of menopause against VVC and risk factors for postmenopausal women in developing VVC, as well as the presentation and treatment of the infection in postmenopausal patients.

Recent Findings

The odds of developing VVC have found to decrease by 7% with each year of age after 57, as predicted by the low glycogen levels occurring in postmenopausal women. However, certain medications and comorbidities such as tamoxifen, antibiotics, sodium-glucose cotransporter-2 (SLGT-2) inhibitors, diabetes mellitus, hormone replacement therapy (HRT), and immunosuppressants have been found to increase the prevalence of VVC in the postmenopausal population.

Summary

Unfortunately, there is still a paucity of literature on the prevalence, risk factors, clinical presentation, treatment, and recurrence of vulvovaginal candidiasis in postmenopausal women. Due to the fact that the vaginal environment, comorbidities, and Candida species are different in this population, the disease is often missed. Future research on VVC should include analysis of postmenopausal women such that providers can confidently educate and treat this specific population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •   Of importance •• Of major importance

  1. World Health Organization. Aging and Health. 2021.

  2. Jeanmond R, Jeanmond D. Vaginal candidiasis. Statperls Publishing; 2021.

  3. Walton EW. Vaginal microbial flora in normal young women. Br Med J. 1979.

  4. Tibaldi C, Cappello N, Latino MA, Masuelli G, Marini S, Benedetto C. Vaginal and endocervical microorganisms in symptomatic and asymptomatic non-pregnant females: risk factors and rates of occurrence. Clin Microbiol Infect. 2009;15.

  5. •• Fischer G, Bradford J. Vulvovaginal candidiasis in postmenopausal women. J Low Genit Tract Dis. 2011;15.

  6. Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1985;152.

  7. Adolfsson A, Hagander A, Mahjoubipour F, Larsson P-G. How vaginal infections impact women’s everyday life Women’s lived experiences of bacterial vaginosis and recurrent vulvovaginal candidiasis. Adv Sex Med. 2017;07.

  8. Erekson EA, Yip SO, Wedderburn TS, Martin DK, Li FY, Choi JN, et al. The Vulvovaginal Symptoms Questionnaire: a questionnaire for measuring vulvovaginal symptoms in postmenopausal women. Menopause. 2013;20.

  9. Benedict K, Jackson BR, Chiller T, Beer KD. Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis. 2019;68.

  10. Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018.

  11. U.S. Bureau of Labor Statistics. Labor Force Statistics from the Current Population SurveY.https://www.bls.gov/cps/tables.hthtm#annual. 2021.

  12. Ochiel D, Fahey J, Ghosh M, Haddad S, Wira C. Innate immunity in the female reproductive tract: role of sex hormones in regulating uterine epithelial cell protection against pathogens. Curr Womens Health Rev. 2008;4.

  13. • Moncla BJ, Chappell CA, Debo BM, Meyn LA. The effects of hormones and vaginal microflora on the glycome of the female genital tract: cervical-vaginal fluid. PLoS One. 2016;11.

  14. Dennerstein GJ, Ellis DH. Oestrogen, glycogen and vaginal candidiasis. Aust N Z J Obstet Gynaecol. 2001;41.

  15. • Naglik JR, Moyes DL, Wächtler B, Hube B. Candida albicans interactions with epithelial cells and mucosal immunity. Microbes Infect. 2011.

  16. Sherrington SL, Sorsby E, Mahtey N, Kumwenda P, Lenardon MD, Brown I, et al. Adaptation of Candida albicans to environmental pH induces cell wall remodelling and enhances innate immune recognition. PLoS Pathog. 2017;13.

  17. •• Hoffmann JN, You HM, Hedberg EC, Jordan JA, McClintock MK. Prevalence of bacterial vaginosis and Candida among postmenopausal women in the United States. Journals of Gerontology - Series B Psychological Sciences and Social Sciences. 2014;69.

  18. Cheng G, Yeater KM, Hoyer LL. Cellular and molecular biology of Candida albicans estrogen response. Eukaryot Cell. 2006;5.

  19. Dan M, Segal R, Marder V, Leibovitz A. Candida colonization of the vagina in elderly residents of a long-term-care hospital. Eur J Clin Microbiol Infect Dis. 2006;25.

  20. Sobel JD, Chaim W, Leaman D. Recurrent vulvovaginal candidiasis associated with long-term tamoxifen treatment in postmenopausal women. Obstet Gynecol. 1996;88.

  21. Pirotta M v., Garland SM. Genital candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J Clin Microbiol. 2006;44.

  22. Xu J, Schwartz K, Bartoces M, Monsur J, Severson RK, Sobel JD. Effect of antibiotics on vulvovaginal candidiasis: a metronet study. J Am Board Fam Med. 2008;21.

  23. Palacios-Ceña D, Hernández-Barrera V, Jiménez-Trujillo I, Serrano-Urrea R, Fernández-de-las-Peñas C, Carrasco-Garrido P. Time trends in antibiotic consumption in the elderly: ten-year follow-up of the Spanish National Health Survey and the European Health Interview Survey for Spain (2003–2014). PLoS One. 2017;12.

  24. Faulkner CM, Cox HL, Williamson JC. Unique aspects of antimicrobial use in older adults. Clinic Infect Dis. 2005.

  25. Farhan MA, Moharram AM, Salah T, Shaaban OM. Types of yeasts that cause vulvovaginal candidiasis in chronic users of corticosteroids. Med Mycol. 2019;57.

  26. Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014.

  27. Goswami D, Goswami R, Banerjee U, Dadhwal V, Miglani S, Lattif AA, et al. Pattern of Candida species isolated from patients with diabetes mellitus and vulvovaginal candidiasis and their response to single dose oral fluconazole therapy. J Infect. 2006;52.

  28. Nyirjesy P, Zhao Y, Ways K, Usiskin K. Evaluation of vulvovaginal symptoms and Candida colonization in women with type 2 diabetes mellitus treated with canagliflozin, a sodium glucose co-transporter 2 inhibitor. Curr Med Res Opin. 2012;28.

  29. •• Halteet S al, Abdel-Hadi A, Hassan M, Awad M. Prevalence and antifungal susceptibility profile of clinically relevant Candida species in postmenopausal women with diabetes. Biomed Res Int. 2020;2020.

  30. • Yokoyama H, Nagao A, Watanabe S, Honjo J. Incidence and risk of vaginal candidiasis associated with sodium–glucose cotransporter 2 inhibitors in real-world practice for women with type 2 diabetes. J Diabetes Investig. 2019;10.

  31. Bosetti C, Negri E, Franceschi S, Trichopoulos D, Beral V, la Vecchia C, et al. Relationship between postmenopausal hormone replacement therapy and ovarian cancer [2]. J Am Med Assoc. 2001.

  32. •• Fischer G, Bradford J. Vulvovaginal candidiasis in postmenopausal women: the role of hormone replacement therapy. J Low Genit Tract Dis. 2011;15.

  33. Özyurt H, Ongut G, Öğünç D, Şimşek T. The relationship between hormone replacement therapy and vaginal candidiasis in postmenopausal patients. Gynecol Oncol. 2008;14.

  34. Gupta S, Kumar N, Singhal N, Kaur R, Manektala U. Vaginal microflora in postmenopausal women on hormone replacement therapy. Indian J Pathol Microbiol. 2006;49.

  35. Heinemann C, Reid G. Vaginal microbial diversity among postmenopausal women with and without hormone replacement therapy. Can J Microbiol. 2005;51.

  36. Kumwenda P, Cottier F, Hendry AC, Kneafsey D, Keevan B, Gallagher H, et al. Estrogen promotes innate immune evasion of Candida albicans through inactivation of the alternative complement system. Cell Rep. 2022;38.

  37. Peters BM, Yano J, Noverr MC, Fidel PL. Candida vaginitis: when opportunism knocks, the host responds. PLoS Pathog. 2014;10.

  38. Centers for Disease Control and Prevention. STI Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/default.htm. 2021.

  39. Potter B, Schrager S, Dalby J, Torell E, Hampton A. Menopause. Primary Care - Clinics in Office Practice. 2018.

  40. Nyirjesy P, Brookhart C, Lazenby G, Schwebke J, Sobel JD. Vulvovaginal candidiasis: a review of the evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines. Clinic Infect Dis. 2022.

  41. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol. 2005;43.

  42. Corsello S, Spinillo A, Osnengo G, Penna C, Guaschino S, Beltrame A, et al. An epidemiological survey of vulvovaginal candidiasis in Italy. Eur J Obstet Gynecol. 2003;110.

  43. Holland J, Young ML, Lee O, Chen SCA. Vulvovaginal carriage of yeasts other than Candida albicans. Sex Transm Infect. 2003;79.

  44. Paulitsch A, Weger W, Ginter-Hanselmayer G, Marth E, Buzina W. A 5-year (2000–2004) epidemiological survey of Candida and non-Candida yeast species causing vulvovaginal candidiasis in Graz, Austria. Mycoses. 2006;49.

  45. Mohanty S, Xess I, Hasan F, Kapil A, Mittal S, Tolosa JE. Prevalence & susceptibility to fluconazole of Candida species causing vulvovaginitis. Indian J Med Res. 2007;126.

  46. Cetin M, Ocak S, Gungoren A, Hakverdi AU. Distribution of Candida species in women with vulvovaginal symptoms and their association with different ages and contraceptive methods. Scand J Infect Dis. 2007;39.

  47. Vermitsky JP, Self MJ, Chadwick SG, Trama JP, Adelson ME, Mordechai E, et al. Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection. J Clin Microbiol. 2008;46.

  48. Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351.

  49. Nwokolo NC, Boag FC. Chronic vaginal candidiasis. Drugs Aging. 2000;16.

Download references

Author information

Authors and Affiliations

  1. Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Mariel Becker & Ryan Sobel

  2. Jefferson Vulvovaginal Heath Center, Thomas Jefferson University, Philadelphia, PA, USA

    Ryan Sobel

Authors
  1. Mariel Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Sobel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariel Becker.

Ethics declarations

Conflict of Interest

RS serves as a consultant for SCYNEXIS Inc., Mycovia Pharmaceuticals. The other author has no conflicts to disclose.

Human and Animal Rights and Informed Consent

The authors of this paper have been compliance with ethical standards. This article does not contain any studies with human or animal subjects performed by any of this article’s authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Topical Collection on Female Genital Tract Infections

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Becker, M., Sobel, R. Vulvovaginal Candidiasis in Postmenopausal Women. Curr Infect Dis Rep 25, 61–66 (2023). https://doi.org/10.1007/s11908-023-00801-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-023-00801-z

Keywords

Search

Navigation