Vaginal thrush — what is it, what causes it, and how to address it

What causes vaginal thrush?

The disruption to the balance of microbes that make up the vaginal microbiome is termed vaginal dysbiosis. Looking at vaginal thrush specifically, there are a range of factors which may disrupt the composition of the vaginal microbiome. While you may have heard of the gut microbiome, the vaginal microbiome is a little different. While a greater diversity of microorganisms is associated with good health in the gut microbiome, this is not necessarily the case with the communities of microbes living in the vaginal environment. In fact, a healthy vaginal microbiome is characterised by low diversity, with dominance of a certain group of bacteria known as lactobacilli. This group of bacteria are beneficial for the vagina as they help to maintain the acidic environment which is necessary for keeping disease-causing microorganisms from creating problems, such as vulvovaginal infections.² Reductions in lactobacilli are often a hallmark of vaginal dysbiosis, as this can mean that more opportunistic microorganisms (like candida) can take hold and cause issues. While specific triggers of vaginal thrush continue to be investigated, factors which can disturb the balance of lactobacilli in the vaginal environment and cause an overgrowth of candida may include medications (e.g. antibiotics), issues with blood sugar regulation (e.g. diabetes), hormonal fluctuations (such as during pregnancy and menopause), and other factors.³

What are the symptoms of vaginal thrush?

Symptoms of vaginal thrush are the result of candida expanding its growth by extending what are called fungal hyphae, which are essentially long filaments which branch out as the fungus grows. This growth is what forms a milky or curd-like discharge characteristic of vaginal thrush. Other symptoms of vaginal thrush accompanying a change in discharge are vulvovaginal irritation, burning, and in some cases pain while urinating.¹

Conventional thrush treatment

When it comes to thrush, medication commonly recommended includes oral and / or topical antifungal medications such as fluconazole. For many women experiencing vaginal thrush, treatment options can often support them with reducing severity of symptoms acutely, however, these treatment options do not tend to address the underlying vaginal dysbiosis as a key driver of vaginal thrush. In addition, up to 57% of women treated with standard oral antifungals such as fluconazole experience recurrence of symptoms within 6 months of treatment, with 9% experiencing recurrent vaginal thrush (at least 4 episodes within a 12-month timeframe).^1,4 This indicates a clear need for effective ways to reduce the uncomfortable symptoms of vaginal thrush whilst also modulating the vaginal microbiome to prevent long term recurrence.

Can probiotics help with thrush?

Vaginal microbiome modulation with probiotics can be achieved when the right probiotic strains are selected for this specific purpose. Each probiotic strain has its own unique mechanisms of action, and certain strains have an affinity for the vaginal environment, such as Lactobacillus crispatus species as a prime example. L. crispatus has demonstrated the most protective effects against vaginal dysbiosis⁵ when investigating the activity of different lactobacilli on vaginal health. Other lactobacilli strains have also proven to be effective in supporting women with vaginal thrush.

One clinical trial in 58 women with recurrent vaginal thrush observed that two other lactobacilli strains - Lactobacillus fermentum LF10 and Lactobacillus acidophilus LA02 - prevented recurrence of symptoms in over two thirds of women who took the probiotic combination.⁴ Alleviation of their symptoms was observed for 7 months after probiotic administration. So when it comes to recurrent thrush, probiotics may therefore be an ideal management strategy to support the health of the vaginal microbiome.

It is important to remember that when it comes to choosing the right probiotics for thrush, it is essential to choose strains which have been shown to support the health of the vaginal environment and target this specific health outcome. Different probiotic strains have been shown to help women with a range of different health concerns.

Can you take probiotics with thrush treatment?

While it may be highly beneficial to take targeted probiotics for thrush prevention, it is also safe to take probiotics alongside conventional thrush treatment like fluconazole, whether this is during an acute flare or to address symptom recurrence. This may be a useful opportunity to support the vaginal microbiome and potentially provide an additional level of protection against the effects of some antifungals which can compromise the delicate balance of microbial species within the vaginal microbiome.

Summary

While vaginal thrush is a bothersome and at times painful condition, understanding that vaginal dysbiosis is a key contributor to thrush means that the uncomfortable thrush symptoms women experience can be addressed with interventions which focus on restoring vaginal microbiome health. Vaginal microbiome modulation with probiotics is one specific, effective, and simple way this can be achieved, especially by using targeted probiotics for vaginal health which have been shown to support the health of the vaginal environment, particularly by supporting health-promoting vaginal species such as lactobacilli.