Menopause is NOT a Predisposing Risk Factor for Vulvovaginal Candidiasis
Menopause is not a recognized predisposing risk factor for vulvovaginal candidiasis, while diabetes mellitus, pregnancy, and oral contraceptive use are all well-established risk factors. 1, 2, 3
Established Risk Factors for VVC
The following are confirmed predisposing factors based on CDC guidelines and current evidence:
Diabetes Mellitus
- Uncontrolled diabetes mellitus increases susceptibility to fungal infections, including Candida species, through multiple mechanisms 2
- High blood glucose levels promote yeast attachment and growth while interfering with immune responses in the host 4
- Patients with poorly controlled glycemia are particularly prone to developing genital mycotic infections 4
Pregnancy
- VVC is common during pregnancy and represents a well-documented risk factor 1
- Pregnancy-related hormonal changes create an environment conducive to Candida overgrowth 2, 3
- Disturbance in reproductive hormone levels due to pregnancy predisposes to infection 5
Oral Contraceptive Use
- Oral contraceptives are recognized as a predisposing factor for vulvovaginal candidiasis 3, 6
- Exogenous hormones, including oral contraceptives, alter the vaginal environment in ways that favor Candida colonization 6
- Gestagens have been shown to be a predisposing factor for vaginal candidiasis 7
Why Menopause is NOT a Risk Factor
Hormonal Environment
- The hypoestrogenic state of menopause creates an unfavorable environment for Candida growth (general medical knowledge)
- VVC predominantly affects women during their reproductive years (70-75% of women affected), with the highest prevalence at ages 25-34 years 2
- The condition requires estrogen-rich conditions for optimal Candida colonization, which are absent in menopause 5
Clinical Evidence
- None of the major guidelines (CDC 1993,2002, or 2021) list menopause as a risk factor for VVC 1
- The comprehensive review of risk factors in Praxis Medical Insights specifically identifies pregnancy, diabetes, immunosuppression, corticosteroid use, and HIV infection—but not menopause 2
- Research literature consistently identifies pregnancy and oral contraceptives as risk factors but does not include menopause 3, 6
Common Pitfall to Avoid
Do not confuse postmenopausal vulvar conditions (such as lichen sclerosus, which does occur commonly in postmenopausal women) with vulvovaginal candidiasis—these are distinct entities with different pathophysiology 8