Recurrent Vulvovaginal Thrush

I was probably a bit disgusted by it as a teenager. I didn’t know what was going on with my body. I was probably quite frightened because I didn’t have the knowledge and understanding that I have now, and I think oral capsules are reasonably new, I don’t think... I can’t remember... I certainly can’t remember them being available when I was a teenager, and so you had to go through that pessary which meant like... and I did find it really quite disgusting, we... all the kind of... and because it kind of comes out over days and that was... at first, I was quite shocked by that initially; I was only little. But now I’m not... I’m not... I’m not... I’m not going to say I’m not bothered because it’s... it’s annoying, but I’m not disgusted or... or any of that. I’d say... I mean it’s annoying and frustrating more than making me sad or making me not like my body or any of those things.

I guess teenagers... I guess they’re sensitive, aren’t they, and I think I don’t have the shame and stigma, but I can understand why they would, and I... I guess it would have helped to know that this is just something that happens for some women and it’s nothing you’re doing wrong, it’s just something that happens to some women and it’s nothing to be ashamed of, there’s nothing to be frightened of.

So, before I think I used to struggle with symptom like two... a few days before my period that, ‘oh my gosh, I'm getting it a few days,’ and now it’s a good solid block of nine, 10 days, and I know that’s the thrush coming on and the period probably coming on at the same time, I don't know, but it’s about 10 days before my period I start getting all these symptoms. Yeah, so I'd say in a month I'd probably have thrush-related symptoms for about maybe half of it because I get it around when I'm ovulating as well, I get a few days of soreness and more than... more than usual because I... I know when you've got your cycle there’s all sorts of different things coming up, but I follow it on a... on my calendar and sometimes I note it down, but yeah, when I'm ovulating, obviously I've got ovulation symptoms, but then I also get mild thrush symptoms. You see that... I don't know if that’s related, I don't know, because sometimes I'm thinking, ‘oh, am I overthinking it just because I've got it all the time?’ but I'm always trying to make note of like where I am in my cycle and when I'm trying to feel it, but those are the days that I feel it, so sometimes I just think it’s almost half a month that I'm struggling with this, which is quite a lot, and now I think about it I'm also getting used to it now, but yeah, it’s... it’s not pleasant.

I think it’s right to say that slowly I've started to realise that it was flaring up before my period. I think when it started, I was so... I was an undergraduate and at university and I was paying absolutely no attention to my body and I was just like, ‘oh, this is happening,’ and then by the time I was like 23 I was like, ‘oh, this is happening when... right after I'm ovulating.’

But I didn’t even really know I had it at that point, because when you’re having your first baby you don’t really know what the symptoms are I suppose, like I just thought that was discharge from being pregnant, do you know what I mean? I didn’t know I had even thrush at that point, do you know what I mean? Because I had it that... on and off that much throughout the years, it’s... yeah, I just... you just, like I say, you just get on with it, and I just thought it was discharge just from being pregnant, I didn’t think it was thrush again, but yeah, I had it again, and I just can’t get rid of it. But a lot... I think a lot women do though, don’t they, when they’re pregnant and that?

It was very much accepted that this... you are more at risk of thrush during pregnancy, and this is how we treat it. It was again, very evidence based, and it was very much not made a big deal. Afterwards, I think it’s possibly considered a little bit more because it’s not something you expect someone to have outside of pregnancy as regularly.

I think the only difference in terms of treatments was that I couldn’t take the... they wouldn’t let me take the oral pill, I think it all had to be done through the creams. I don’t... from memory, I don’t think they allowed me to use some of the pessaries as well, or... it was either that or they had told me I had to maybe use like an internal cream, I think, so yeah, the treatment was slightly different and obviously the approach is kind of... I don’t know, I.... I don’t feel like they’re as kind of supportive because obviously they’re a bit wary of you using treatments with pregnancy, and I don’t think they fully know you know what... what’s sort of safe for things, because some people would say, ‘oh, you know, yeah, you can use the pessary, that’s absolutely fine;’ other people would say, ‘oh, you’ve got to insert it yourself,’ like using your fingers; some would just say it wasn’t advised at all. 

I found like... so after I had kids, I didn’t have it when I was preg... I think it must be a... and I don't know, because obviously I can’t... really don’t really feel like I can explore it with anyone, but I feel like it must be a hormonal thing given that it comes the week before a period, and I also think when I was pregnant, I didn’t get it, and I breastfed both kids for two years. So, after both kids I didn’t get... because I was breastfeeding, I didn’t get my period back for like 14 months, and in that period, I didn’t get it at all, and then as soon as my periods returned and the hormone... like back to normal cycle, then I started getting it a week before each period.

I guess one con... well, yeah, one concern or one like worry I do have is that I know that you’re not supposed to take fluconazole during pregnancy, so I know that that’s something I’m going to have to probably, hopefully, I guess approach at some point, is what I do if I become pregnant, because I know that’s also, as far as I understand, like often people experience thrush during pregnancy, even people who don’t normally experience thrush, and so I’m like, ‘Well, I’m definitely going to get that then, aren’t I?’ [chuckles] And to be honest, I... like, I haven’t thought about it in that much detail, but I sort of know that that’s something that’s sort of on my radar as at that point I’ll have to... I’ll probably go back to my doctor and ask if there’s anything else I can do, any other treatment that I could take because I wouldn’t be able to carry on with what I’m doing at the moment, so that’s like on my radar.

Oh, and also about worries and hopes for the future: when I was like in the thick of the thrush and had the miscarriage and infertility, I was worried it was one of the reasons I was infertile, was that, the whole my vagina and maybe it was getting into my womb or something and creating... you know like the coil, like it sets off your immune system and that’s why you don't get pregnant, so I was worried that like my immune system was really active in the area and maybe that’s why I wasn't getting pregnant as well, so it did make me worry about my fertility.

I think they just said, ‘no effect,’ or, ‘no studies have shown an effect.’

I have HRT twice a week and I notice a difference before I take my next dose, you know there’s all sorts of subtle differences, and it feels like the... when... you know it feels like the thrush is more susceptible when that flesh is more kind of wrinkled, smaller, tighter, got more folds in the skin I guess, and what I notice is the kind of plumper and better sort of moisturised it is, the less folds it has, I think the less it seems to be getting infections.

So, it kind of feels like that, and it just feels like I'm going to be working with that forever, and presumably at different points as my skin changes again as I get older, then I guess it’ll change again. I don't know if older women suffer with thrush. Like I suppose I think of it as a young woman’s problem, but I'm 51 now, so obviously it’s not quite true.

Symptomatic thrush can be experienced by anybody throughout their life, and that starts right from before your periods start before puberty to after the menopause.

And the thrush is the same. But sometimes the way in which it interacts with the stage that your body is at can change a little bit.

And one important example of this is that after the menopause and after periods stop when they're lower levels of oestrogen in the body, the skin around the vulva and the vagina can already become a little bit drier and a bit more delicate. And that can sometimes be mistaken for thrush, but also it can potentially aggravate the discomfort or distress if you've got itch. And that also goes, of course, throughout the whole course of your life, if you have another condition or skin condition affecting that area.

These are important reasons why, if you've got difficult symptoms, particularly symptoms that aren't getting better with something that you've tried yourself, with something that's worked for you before, that it's really, really important to go see a doctor, talk about the difficulties you're having, and arrange a time in a place where that can maybe be looked into further, usually with kind of somebody having a look and doing an examination and maybe some check-ups.

It is quite difficult to read that there’s nothing for this condition and that I’m going to have to live with this till I... I guess I hit menopause I think, I think, in my head that’s my theory, I don't know if that’s correct, I don't know, because I don't know anyone else personally in my life that’s had it for so long. Obviously, you know, everyone’s had like a bout of it here and there due to either pregnancy or where it like really... where it is just like they've had it but they've not had more than one or two episodes, so... but they can understand and they can sort of be like, ‘oh my gosh, you get that every month,’ I'm like, ‘yeah, kind of for half the month actually,’ you know other things happen around it as well, but yeah, it... it’s quite difficult.

I’m looking forward, to be honest, I don’t... I need to do a bit more homework I think about thrush, like in my older years, you know thrush and older women, that you know it would be nice to sort of learn a bit more about that, but I’m looking forward to having the... because I haven’t got kids, I... I know this is... this obviously I... I don’t joke... well, I have joked about it, but I... because I haven’t got kids and stuff, I just want to... like when my ovaries pack up, I’ve said like I just want to throw... and I used to say to my late mother-in-law, bless her, that I’m going to throw a party when my ovaries pack up, because obviously I don’t want kids, so... you know I’m going to you know celebrate not having any you know functioning ovaries anymore, you know I’m not bothered sort of thing, and... and you just... I just kind of want it all to.

You know so... but definitely, I will... you know I’m wise enough to sort of be a lot more vigilant about things going forward, you know especially lady’s stuff down... you know anything related to that. You know when I have obviously the menopause. You know I do believe that I’m going through perimenopause as well at the moment you know because I’m still getting the hot flushes and stuff, you know so I will be looking for signs obviously with that, you know going forward. 

But then also because it drives me so... so crazy, at the moment I’m like I’m not take... I like stop... as soon as I stopped taking T (testosterone), I stopped having thrush, so then I was just like, ‘oh, maybe I’m just not going to bother because it’s... because I really can’t be bothered with all of like... these like hormonal changes, la-la-la,’ so I’m sort of... I’m on the fence at the... I mean I’ve got thrush at the moment, which is so annoying, so I’m on the fence, but I don’t really know... I haven’t really thought my game... I think because I’m in my own sort of like journey of like, ‘do I want to keep taking it, do I not, can I be bothered with these side effects, can I not?’ so it’s... yeah.