VAGINAL THRUSH PRODUCTS

Antifungal drugs

Thrush is caused by a fungus (candida), and is therefore treated with antifungal drugs. Treatments are available as:

• Pessaries to be inserted into the vagina
• Creams to be put on the vulva and/or into the vagina
• Capsules to be swallowed

Treatments can be bought over the counter at a chemist, but they may be cheaper (or free) if you get them by prescription.

Pessaries and creams

Pessaries and creams work directly at the site of infection - in the vagina and on the outer lips of the vagina.

Pessaries are bullet-shaped tablets that can be either hard or waxy. They need to be pushed high into your vagina with your finger or an applicator.

There are two types of creams used to treat thrush: vaginal and vulval. Vaginal creams work internally and, like pessaries, are inserted into the vagina using an applicator. Vulval creams are usually used with an internal treatment, to help soothe and treat itching outside the vagina.

Pessaries and creams can be messy - they melt and leak out into your pants - so it’s best to insert them at night just before you go to bed. You may also want to use a panty liner, as some treatments are coloured and can stain.

Length of treatment

The length of treatment varies with different brands of pessaries and creams. It may last one day, three days, six days or 14 days. You don’t need to stop treatment if you get your period. In fact, it’s important to complete the full course of treatment, even if your symptoms seem to have cleared.

The active ingredient in pessaries and creams may be clotrimazole, econazole, fenticonazole, miconazole or nystatin. Nystatin is a little bit different than the other drugs. It is a more general antifungal that works against a range of fungi and yeast. It can take longer and may be less effective at curing thrush than the other antifungal preparations.

Side effects

The potential side effects are the same for all of the drugs listed above: skin irritation and burning. Side effects from pessaries and creams are thought to be rare, but as they mimic the symptoms of thrush it may be difficult to tell the difference.

Recurrent thrush

Women who get thrush again and again (four or more times a year is considered recurrent) may be given pessaries as prevention. These are long-acting pessaries taken either twice a week, once a week or once a month over a three to six month period.

Allergies, irritation and drug interaction

If you have a peanut allergy, avoid vaginal creams that contain arachis oil.

Betadine pessaries, used to treat recurrent thrush, are iodine-based and may cause irritation. To reduce irritation, moisten the pessary with water before inserting it.

Pessaries and creams containing miconazole may cause bleeding and bruising if taken at the same time as warfarin - a prescription blood thinning drug.

Pregnancy and breastfeeding

Pessaries and creams are not well absorbed into the body’s circulation and are therefore unlikely to affect a developing foetus, but there has been little research into their use during pregnancy. Treatments with clotrimazole have been used by pregnant women for years and are considered safe. But iodine-based pessaries, such as betadine for recurrent thrush, should not be used during pregnancy. Some experts advise against using econazole during the first three months of pregnancy. If you are pregnant and have thrush, talk to your doctor or midwife about treatment.

Damage to barrier contraception

Some pessaries and creams can damage the rubber of diaphragms and condoms, making them useless as contraception.

Drugs taken by mouth

Thrush can also be treated with capsules that you swallow. These are available either as a single dose (fluconazole) or as two capsules to be taken in the same day (itraconazole). Many women prefer pills to creams or pessaries, but they are more likely to cause side effects and should not be used if you are pregnant, breastfeeding or taking certain medication.

Side effects and drug interactions

Oral medication for thrush may cause nausea, diarrhoea, abdominal pain, dizziness or skin rash. It may also cause more serious problems if you are using it at the same time as other drugs such as loratadine (an antihistamine used in some allergy medication). If you are taking medication for another condition, check with the pharmacist or your doctor before taking antifungal tablets.

Recurrent thrush

When thrush keeps coming back, it may be a signal that yeast has taken over another part of the body, such as the intestines. If this is the case, vaginal pessaries and creams will not be able to treat the whole problem. Oral tablets fight yeast throughout the body and therefore are often prescribed for women who have recurrent thrush.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding you should not use oral treatments for thrush. Some pessaries and creams may be safe to use, or you may want to consider alternative treatments (next section, below). It is always a good idea to check with your doctor or midwife before using any treatment while you are pregnant.

Complementary and other threatments

There is also a range of alternative or complementary treatments for thrush. Not all of these treatments are supported by research, but many women find them useful. Complementary treatments tend to be most effective when used as soon as you begin to notice the symptoms of thrush.

Calendula

Calendula (from marigold flowers) is both anti-fungal and soothing. Calendula pessaries for thrush are available at some health food stores. Calendula cream or gel may be helpful if applied directly on the irritated area outside of your vagina. Do not put a cream or gel into your vagina unless it says on the package that it is safe to use internally.

Garlic

Garlic has strong antibacterial and anti-fungal properties, and may help stop thrush in some women. Peel a clove of garlic (be careful not to nick it), wrap it in muslin, to make sure you can remove it, and insert it into your vagina. Leave the garlic in overnight. Be prepared to smell quite strongly of garlic while you are using this treatment.

Tea tree oil

Some women find tea tree oil helpful in stopping thrush. Its effectiveness in fighting candida albicans is also supported by scientific studies. To use tea tree oil for thrush:

• put tea tree oil on the tip of a tampon and insert it into your vagina
• put tea tree on a panty liner or towel
• dampen cotton wool with tea tree (mixed with water) and gently wipe around the vaginal area

Some health food stores carry ready-made tea tree oil pessaries and manuka oil salve (manuka is another type of tea tree). Look in the women’s health section or ask the sales assistant. Be aware that tea tree may sting at first, but it should stop after a short while.

Lactic acid wash

This is a relatively new product now available at larger chemists. The wash, to be used externally, contains lactic acid that helps maintain the natural pH balance in the vaginal area. This prevents yeast from taking hold. It can be used as a daily wash instead of soap, or as a treatment when you feel thrush may be developing.

Vinegar

Some women find vinegar can help stop thrush but, as with garlic, the smell is quite strong. Vinegar is acidic and may help restore the pH balance of the vaginal area to give the friendly bacteria a better chance of successfully fighting off yeast. Never use vinegar on its own - it must be diluted with water (1 tablespoon vinegar with 1 pint of water). You can also add acidophilus to the mixture (see yoghurt below). Use the mixture to gently wash the outside of your vagina or dip a tampon in it and insert it over night.

Yoghurt

Natural live yoghurt can be used in two ways to deal with thrush: eating it and/or inserting it into your vagina. The key is not the yoghurt itself but the bacteria, lactobacillus acidophilus, in the yoghurt. This helps the body maintain, or regain, its natural pH level and keeps yeast under control.

Eating yoghurt may help keep yeast levels low throughout the body, but particularly in the stomach and intestines. Because candida in the bowel can easily make its way to the vulva and vagina, keeping your digestive system clear of thrush may help prevent vaginal thrush.

Inserting yoghurt into your vagina may also help restore your vaginal pH balance, but there is less scientific support for this method. If you want to give it a try, put one teaspoon of yoghurt in an applicator, a plastic syringe or on a tampon, and insert it high into your vagina. Repeat this every night for a week. It is important that you use only unsweetened, plain, live yoghurt.

The active ingredient in this treatment, lactobacillus acidophilus, is also available at health food stores as a supplement on its own.