From the Guidelines
Birth control pills can increase the risk of yeast infections in some women, with hormonal contraceptives disrupting the vaginal pH balance and increasing glycogen levels in vaginal tissues, creating an environment where Candida fungi can thrive. According to a recent study 1, the diagnosis of vulvovaginal candidiasis (VVC) is often challenging, with microscopy and clinical suspicion having poor sensitivity, while yeast cultures can lead to a delay in diagnosis and treatment. Women using hormonal birth control methods may experience a 2-3 times higher likelihood of developing vaginal candidiasis compared to non-users.
For treating yeast infections, over-the-counter antifungal medications like clotrimazole, miconazole, or fluconazole as a single 150mg oral dose are effective options, as recommended by the 2021 Centers for Disease Control and Prevention (CDC) guidelines 1. The recommended regimens for treatment of VVC include:
- Over-the-counter intravaginal agents, such as clotrimazole 1% cream, 5 g intravaginally daily for 7–14 days
- Prescription intravaginal agents, such as terconazole 0.4% cream, 5 g intravaginally daily for 7 days
- Oral agent, fluconazole 150 mg, single dose
To reduce the risk of yeast infections while continuing birth control, it is essential to:
- Maintain good hygiene
- Wear cotton underwear
- Avoid douching
- Limit sugar intake However, no evidence supports the use of alternative treatments, including probiotics 1. If you experience frequent infections (more than 4 per year), consult your healthcare provider for evaluation of underlying causes and possibly longer-term preventive strategies.
In terms of treatment, oteseconazole, a novel oral highly-selective inhibitor of fungal lanosterol demethylase (CYP51), has shown promising results in clinical trials, with remarkably lower rates of recurrence compared to placebo 1. Additionally, a vaccine targeting a hyphal virulence factor of Candida albicans has also been evaluated for the treatment of RVVC, showing safety, immunogenicity, and capability of reducing the frequency of symptomatic VVC for up to 12 months, but only in a subset of women under 40 years of age 1.
From the Research
Birth Control and Yeast Infection Incidence
- The relationship between birth control methods and yeast infection incidence is not directly addressed in the provided studies 2, 3, 4, 5.
- However, the studies discuss the effects of different contraceptive methods on the vaginal microbiome and hormonal changes, which can potentially influence the risk of yeast infections.
- One study found that combined hormonal contraceptives can promote vaginal eubiosis, with a prevalence of a healthy vaginal microbiome in which Lactobacilli predominate 3.
- Another study noted that hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, but did not specifically mention yeast infections 2.
- The studies primarily focus on the effects of contraceptive methods on lactation, breastfeeding, and sexual health, rather than yeast infection incidence 4, 5.
Contraceptive Methods and Vaginal Microbiome
- The use of combined hormonal contraceptives, such as oral contraceptive pills, can influence the vaginal microbiome 3.
- Progestin-only and nonhormonal methods, such as implants and condoms, may have different effects on the vaginal microbiome compared to combined hormonal contraceptives 3.
- The vaginal microbiota is unique and normally dominated by Lactobacillus species, which provide a degree of protection against infections 3.