Perimenopause can feel like an adventure you didn’t sign up for — a period of transition with changes that might catch you off guard. One of those unwelcome surprises? Vaginal yeast infections.

A lot of factors influence your risk of developing a yeast infection, and hormonal fluctuations like the ones your body goes through in perimenopause are one of them. Let’s unpack the connection between perimenopause and vaginal yeast infections, and what you can do to manage it.

What is perimenopause?

Perimenopause is the transitional phase leading up to menopause, typically starting in your 40s but sometimes as early as your mid-30s. It can last anywhere from a few months to over a decade. During this time, your hormone levels decrease (primarily estrogen and progesterone), causing a cascade of changes in your body. 

Symptoms like irregular periods, hot flashes, mood swings, and sleep disturbances are common. But one area that often gets less attention is how these hormonal shifts affect vaginal health.

How hormonal changes impact vaginal health

Estrogen plays a crucial role in maintaining a healthy vagina. It helps keep the vaginal lining thick, elastic, and well-lubricated, as well as supports the balance of healthy bacteria (primarily Lactobacilli) that prevent overgrowth of harmful microorganisms. During perimenopause, fluctuating and declining estrogen levels can lead to:

  • Thinning of the vaginal walls: Sometimes referred to as vaginal atrophy, this can make the area more susceptible to irritation and infections.
  • Reduced vaginal lubrication: Dryness can create an environment where yeast is more likely to thrive.
  • Changes in pH balance: A higher vaginal pH (less acidic) can disrupt the delicate ecosystem of the vagina, allowing yeast and other pathogens to grow.

What are vaginal yeast infections?

Vaginal yeast infections (vaginal candidiasis) are a type of fungal infection caused by an overgrowth of Candida, a type of fungus that naturally exists in small amounts in your body. When the balance of bacteria and yeast in the vagina is disrupted, Candida (most commonly, Candida albicans) can multiply and lead to uncomfortable symptoms. Yeast infection symptoms include:

  • Vaginal itching and irritation
  • Thick, white, cottage cheese-like discharge
  • Redness and swelling
  • A burning sensation, especially when you pee or have sex. 

Perimenopause and yeast infections

Several factors during perimenopause can increase your susceptibility to vaginal yeast infections:

  1. Hormonal shifts: Fluctuating estrogen can disrupt the natural balance of vaginal flora.
  2. Vaginal dryness: Lack of lubrication can irritate the vaginal lining, making it easier for yeast to take hold.
  3. Higher pH levels: A less acidic vaginal environment favors yeast overgrowth.‍
  4. Weakened immune response: As you age, your immune system may become less effective at keeping infections at bay.
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Tips for prevention and relief

Because of the changes your body goes through during perimenopause, vaginal infections can feel completely out of your control (and in some aspects, they are). That said, having a proactive approach can support your vaginal microbiome and reduce your risk of developing a yeast infection.

  • Maintaining proper hygiene: The vagina is a self-cleaning organ, so you don’t need to use any products to “keep it fresh”. To wash your vulva, simply use warm water and a gentle, fragrance-free soap. Also, make sure to change pads and tampons within the recommended time frame to prevent bacterial overgrowth, which could weaken your vaginal flora and give yeast a chance to colonize.
  • Don’t ignore dryness: If you’re experiencing any dryness, consider using a vaginal moisturizer like Evvy’s Hyaluronic Acid Suppositories and Soothing Vulva Cream on the exterior. If over-the-counter solutions aren’t cutting it, speak to your healthcare provider. 
  • Look after your microbiome: There are a few things you can do to support your vaginal microbiome in perimenopause. For one, ditch the douche. Douching can disrupt the natural balance of vaginal bacteria and put you at higher risk of inflammation and infections. You can also up your intake of probiotic-rich foods or use a probiotic supplement specifically formulated for the vaginal microbiome to replenish good bacteria. And finally, monitor your vaginal microbiome with Evvy’s Vaginal Health Test, which uncovers over 700 bacteria and fungi and gives you a breakdown of your microbiome.
  • Practice safe sex: You may be tempted to omit condoms when you have sex. Though your chances of getting pregnant are indeed lower in perimenopause (they’re not zero), unprotected sex can be a trigger for vaginal yeast infections. Using barrier methods like condoms and dental dams prevents unwanted pathogens from entering the vaginal tract, and stops semen and saliva from altering the vaginal pH.

When to seek medical advice

If symptoms persist despite over-the-counter remedies or if you are unsure whether they are due to a yeast infection, consult a healthcare provider.

Other conditions, such as bacterial vaginosis (BV) or sexually transmitted infections (STIs), can mimic yeast infection symptoms but require different treatments. You should speak to a healthcare provider if you notice:

FAQ

How do you get rid of a hormonal yeast infection?

To treat vaginal yeast infections during perimenopause, you need to address both the infection and the underlying hormonal changes. Over-the-counter antifungal treatments, such as creams, suppositories, or oral medications, can help clear up the infection. If you're experiencing recurrent yeast infections, talk to a doctor about prescription-strength treatments or maintenance options such as boric acid. Balancing pH and microbiome health is also essential, so using vaginal probiotics may help restore good bacteria. Keeping the vaginal area dry and avoiding irritants like scented soaps or tight clothing can prevent further irritation. 

Can perimenopause cause itching down there?

Yes, perimenopause can cause itching in the vaginal area. As estrogen levels fluctuate and decline, the vaginal tissues become thinner, drier, and less elastic. This dryness (referred to as vaginal atrophy) can lead to irritation, itching, and discomfort. Additionally, changes in pH and the balance of good bacteria can make the area more susceptible to infections, such as vaginal yeast infections or bacterial vaginosis, both of which can cause itching. If the itching is persistent or severe, it's a good idea to consult a healthcare provider to rule out infections and explore treatments like vaginal moisturizers, estrogen therapy, or other relief options.

Is yeast infection a symptom of low estrogen?

Vaginal yeast infections can be more common with low estrogen levels, but they are not a direct symptom of estrogen deficiency. Lower estrogen levels contribute to changes in the vaginal environment that make yeast infections more likely to occur. Estrogen helps maintain a thick, elastic vaginal lining, promotes natural lubrication, and supports the growth of healthy Lactobacilli bacteria that keep yeast in check. When estrogen levels drop — such as during perimenopause and menopause — the vaginal tissue becomes thinner and drier, pH levels rise, and the protective balance of bacteria can be disrupted. These factors make it easier for Candida (the fungus responsible for vaginal yeast infections) to overgrow. If you're experiencing recurrent vaginal yeast infections along with vaginal dryness or irritation, it may be helpful to talk to a healthcare provider about, vaginal moisturizers, or other treatment options.