Imagine this scenario – you’ve been getting symptoms such as vulval itching and redness so you treat it with an over-the-counter thrush cream. The symptoms go. Must have been thrush, right?

It happens again later, but this time the treatment doesn’t work. So you try something else – maybe a pessary or an oral antifungal. Still getting symptoms…

Eventually, you get a swab from your GP, but the results don’t show anything definitive.

So you do a bit of research and decide to go on a strict anti-Candida diet and take several strong natural products that wipe everything out.

But now your gut’s feeling off, you’re anxious about everything you’re eating, and somehow you’re no closer to answers.

You go back to your doctor, and this time you’re given an antidepressant.

How did you end up here!?

Now take this story, and swap out thrush for recurrent UTIs, or BV, or interstitial cystitis. It’s a common journey for so many people, and it can be incredibly frustrating when symptoms keep recurring and you’re left without clear answers. Sometimes things do get picked up early and treatment is straightforward – but often I hear variations of this story, where people don’t fully know what’s causing their symptoms, or they’re led to believe it’s just something they have to live with. Others are placed on long-term medications they don’t feel comfortable with or are never told there may be an underlying imbalance.

A different approach –

When looking into vaginal microbiome health it’s important to have a good idea what you’re working with.
Most people are familiar with the classic symptoms of Candida/thrush – itching, redness, discharge. But sometimes it can present in less typical ways – for example, with only skin irritation or splitting, and no discharge at all. And importantly, Candida is just one type of imbalance. There are many microbes that can disrupt vaginal health – including bacteria linked to BV or chronic UTIs, and others that can trigger inflammation or discomfort without a clear “infection.”

So how do you find out what the cause is?

First and foremost we look at signs and symptoms. The colour, texture, sensations and odour of vaginal discharge can be very informative. Then we can narrow down whether the environment is too acid or alkaline, something that has a big impact on determining what sort of microbes can grow.

After examining symptoms, we can look at vaginal pH – an easy thing you can do at home to monitor the fluctuates from day to day. Vaginal pH is a good indicator of whether the condition is bacterial or fungal, and can show changes before symptoms appear.

A typical swab performed by the GP can also provide a lot of insight. Things like the presence of clue cells, leucocytes, what can be cultured, and whether bacteria appears to be there regardless of whether we know what type it is or not. However, Candida and other microbes don’t always show up on the day of testing, especially in cases of RVVC (recurrent vulvovaginal candidiasis), which can wax and wane.

This can often be enough. But if we need to dig deeper a more in depth vaginal microbiome test can be helpful.

There are several versions of vaginal microbiome testing available, currently my preference is through Nutripath which I discuss in the below video.

What is a microbiome?

A community of microorganisms that exist within an area of our body contributing to that spaces function and wellbeing. In female reproductive health we commonly refer to the vaginal microbiome – that microbiome that exists within the vagina and also affects the vulval tissues, as well as the endometrial microbiome (impacting the uterus and surrounding fluids) which may be different depending on cervical competency, and the peritoneal fluid microbiome. In the case of RVVC and chronic BV the vaginal microbiome is the most relevant.

Unlike the gut microbiome, the vaginal microbiome is meant to be relatively low in diversity. In most people, it’s dominated by Lactobacillus species, which help keep the environment slightly acidic and defend against invaders. There are variations in the vaginal microbiome based on hormonal stage (e.g. puberty, pregnancy, menopause) and even across the menstrual cycle. The type of lactobacillus that is dominant may vary based on your genetics, referred to community subtype (CST).

Signs of vaginal microbiome imbalance

• Itching in the vulval or vaginal tissues
• Redness or irritation
• Discomfort or soreness of the vulva or vagina that’s not related to
• Discharge that does not fit the typical ovulation discharge pattern
• Discharge that has a fishy, yeast, acidic, or “rotten/off” smell
• Recurrent UTIs
• Splitting in the creases
• Gushing or watery discharge (a clue depending on the microbe involved)
• Symptoms that flare or change during different phases of your menstrual cycle

Underlying Drivers of Vaginal Microbiome Imbalance

There’s no single cause for microbial imbalance. Often, several systems in the body interact and contribute. Here’s a breakdown:

• Gut health: Our gut is integral in almost all facets of our health and wellbeing. The impact of gut health on vaginal health may be different to what you may think. While older theories linked gut Candida to vaginal thrush, newer research shows this is unlikely due to the gut’s low-oxygen environment. RVVC is not typically caused by reinfection from the gut. Our gut health has an impact because of it’s influence on things like our immune system, hormonal balance, nutritional status and inflammation levels such as histamine tolerance. While gut candida is uncommon, and if present does not typically cause RVVC it is still important that we support gut microbiome in chronic dysbiotic cases.

• Oral health: Poor gum and oral health can drive systemic inflammation, which in turn can affect microbial balance elsewhere in the body.

• Immune health: An immune system that’s either overactive or suppressed can make it harder for the vaginal microbiome to stay balanced. Histamine excess can perpetuate chronic vaginal/vulval symptoms and can cause a heightened reaction when candida is present. There is a relationship between hormonal imbalance and mast cell activation issues that can feed RVVC.

• Hormonal balance: Both high and low oestrogen can create imbalances. In cycling women, this may lead to fluctuating symptoms throughout the month. In menopause, reduced oestrogen means less glycogen in vaginal tissues – a critical food source for Lactobacilli – leading to lower populations of these protective microbes. PCOS can be associated with a unique discharge pattern, and hormonal contraceptives like the OCP can alter both microbiome composition and typical discharge characteristics. Supporting hormonal balance is often a key goal in treating vaginal dysbiosis.

• Stress and nervous system regulation: Chronic stress can shift immune function, disrupt hormonal signalling, and create conditions in which opportunistic microbes thrive.

• Medication use: Antibiotics, antihistamines, and even some hormonal treatments can alter microbial environments by reducing protective species.

• Diet and lifestyle: High sugar and low-fibre diets, synthetic underwear, scented products, improper use of soaps or douching and certain sexual practices can disrupt pH or microbial stability.

The Complexity of Candida and RVVC

Recurrent vulvovaginal candidiasis is notoriously difficult to manage. One major challenge is timing – it may not show up on a swab done at your GP’s office if you’re between flares. But days later, symptoms can spike again.

And while low Lactobacilli is often linked to chronic Candida, this isn’t always the case. Some women have recurring Candida issues despite normal pH and healthy levels of Lactobacilli. In these cases, the key lies in addressing deeper factors – not just treating the yeast, but looking at immune regulation, inflammation, and systemic triggers.

The Broader Impact on Fertility and Reproductive Health

A disrupted vaginal microbiome can affect far more than just comfort. Studies link dysbiosis with higher miscarriage rates, IVF failure, and unexplained infertility. It may also fuel systemic inflammation via LPS production, worsening conditions like endometriosis and adenomyosis.

Both male and female reproductive microbiomes play a role in conception. The quality of the vaginal environment can influence sperm survival and how the sperm and egg interact.

What Can Be Done About It?

Effective treatment requires more than just “killing off” whatever shows up in a test. This is where working with a practitioner can make all the difference.

I’ve completed extensive training in vaginal microbiome care and offer tailored support – including custom pessaries and individualised treatment plans that target your unique underlying drivers.

A treatment strategy will typically involve:

• Supporting and regulating hormone balance

• Calming inflammation

• Addressing metabolic health and blood sugar regulation

• Modifying lifestyle and sexual practices as needed

• Supporting local vaginal tissue repair and resilience

• Enhancing immune function

• Restoring nervous system regulation and reducing chronic stress load

• Optimising diet, nutrient intake, and specific nutritional markers

• Identifying and targeting key pathogens where necessary

• Using timing strategies to prevent symptoms before they begin

• Balancing vaginal pH

• Supplying prebiotic fuels to feed beneficial microbes

• Using specific probiotics

References

Bradfield Strydom, M., Nelson, T.M., Khan, S. et al. The impact of fluconazole use on the fungal and bacterial microbiomes in recurrent Vulvovaginal Candidiasis (RVVC): a pilot study of vaginal and gastrointestinal site interplay. Eur J Clin Microbiol Infect Dis 44, 285–301 (2025). https://doi.org/10.1007/s10096-024-04999-1

Ono, Y., Kobayashi, Y., Shimada, S., Fukushi, Y., Yoshino, O., Wada, S., & Yamada, H. (2024). Uterine Endometrium Microbiome in Women with Repeated Implantation Failure Complicated by Endometriosis. Journal of clinical medicine, 13(16), 4605. https://doi.org/10.3390/jcm13164605

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Endometriosis is a multifaceted gynaecological condition that affects many people with uteruses from as early as the first menstrual cycle, and possibly well into menopause. It is believed to be associated with a complex interplay of genetic, hormonal, and immune system factors that drive inflammation. A lesser known player that influences endometriosis is our microbes, in particular the bugs of our vaginal and digestive microbiome.

The vaginal microbiome is a complex ecosystem of bacteria, fungi, and other microorganisms that plays a crucial role in maintaining the health and function of the female reproductive system. In recent years, there has been growing evidence to suggest that changes in the microbiome of the vaginal and peritoneal fluid (the fluid which are reproductive organs exist within) may be associated with endometriosis.

Typically people without endometriosis are not shown to have many microbes within the peritoneal fluid, whereas those with endometriosis have been found to have dysbiosis of this area.

Photo by Alexander Krivitskiy on Unsplash

The vaginal microbiome can be imbalanced at many stages of life, however a long term imbalance such as in chronic candida can contribute towards inflammation and perpetual irritation of the nerves, aggravating the pain associated with endometriosis.

Dysbiosis within the digestive system can also aggravate endometriosis due to the increased production of lipo-polysaccharides (LPS) from dysbiotic bacteria, which contributes towards growth of endometrial lesions, increased inflammation and pain. Our gut bacteria play a large role in the balance of our immune system, and imbalances within our gut bacteria can disrupt this, worsening the inflammation of endometriosis which is driven by altered immune function.

If only correcting our microbiome was the sole answer, but it is part of the jigsaw puzzle.

You may be interested in these articles:

Endometriosis – Natural Management Options

Updates on Endometriosis

Thrush

10 Ways to Ease Period Pain

Endometriosis – an overview

The complexity of endometriosis makes it an overwhelming condition to tackle by yourself. Please don’t hesitate to get in touch if you would like to work together to improve this condition.

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Thrush – it’s something that most women have experienced at least once in their lives. Vaginal thrush is a fungal infection caused by an overgrowth of Candida, a type of yeast. Candida albicans is the most common species of the Candida family, and when it becomes overgrown this can be referred to as a Candida infection, a yeast infection, thrush, or Candidiasis.

Normally, Candida lives harmlessly within our digestive system, however if our immune system or gut flora is disrupted an overgrowth of the yeast can occur. For most people who experience an overgrowth it is only a temporary, albeit unpleasant occurrence. Genital thrush is more common in women than men, and oral thrush can occur in the sick, the very young and the very old. Systemic candida can occur in those with a very weak immune system.

Symptoms

The symptoms of a vaginal thrush infection can include:

• Inflammation (swelling and redness) of the affected skin
• A creamy or cottage cheese like discharge that may be white or slightly yellow, and can have no smell or a slightly yeasty smell.
• Itching and/or pain

Types of Candida

Candida albicans is the most common species that causes thrush, however there are some less common forms of Candida which are becoming more prevalent, most likely due to resistance to the commonly used forms of antifungal treatment. These types include Candida glabrata and Candida rugosa.

Why does it happen?

While it’s fairly common to get thrush after a course of antibiotics, if thrush sticks around for a long time or is recurrent, then there may be some other causes.

This article is not exhaustive, so if you’re dealing with a difficult to shift thrush issue then consult a practitioner who can help you get to the bottom of the problem.

Have you ever wondered why you get thrush more if you’re on the oral contraceptive pill? Or why pregnant women commonly experience thrush? Oestrogen levels have a lot to do with it – when oestrogen is consistently high and doesn’t fluctuate as it normally would in a monthly cycle it sets up an environment that Candida can grow in easily.

Pregnancy and being on the Pill aren’t the only instances where oestrogen levels are high – some women with hormonal imbalances, thyroid disorders, poor detoxification of oestrogen and exposure to xeno-oestrogens (chemicals which interact with oestrogen receptors) will also be more susceptible to thrush.

If the vaginal environment is disrupted, such as change in the normal vaginal pH (3.5-4.5) or the normal flora (mostly lactobacilli) this also sets up an environment where Candida can grow. Some things you may not know that affect this environment are spermicides, semen, douching, regular use of diaphragms, as well as getting your period (blood has a pH of 7.35-7.45).

If your immune system isn’t up to scratch this can also allow Candida to grow more readily. This can happen during periods of stress, as a result of poor diet and/or nutritional deficiencies such as vitamin c and zinc, use of steroid or immunosuppressant medications, after chronic infections (including glandular fever but most notably HIV), as well as during pregnancy (the immune system changes during pregnancy to allow a foreign body to exist within you – isn’t the body amazing?). People with diabetes are also more susceptible to yeast infections.

Does your diet affect thrush?

The “Anti-Candida” diet is well known method to keep thrush at bay. It involves strictly avoiding all sugar, refined carbohydrates and in some instances the recommendation is also to avoid yeast containing foods (such as breads and beer), and fermented foods.

When patients who have been following this diet seek my help, I observe that the diet often causes a lot of stress as any lapses in the condition can cause the person to blame themselves, attributing it to a ‘slip up’ in their diet.

I recommend keeping sugar and refined carbohydrates to a minimum for the majority of people, and you have most likely heard me prattle on about the importance of a whole food diet in the past as well, so it should come as no surprise that I would suggest to someone who is experiencing thrush to avoid sugar and refined carbohydrates (as much as possible), but in no instance would I recommend doing it to such a degree that it causes stress.

While I think the dietary component is important in dealing with thrush, it’s not the only factor. It is common for fluctuations of chronic Candida infections to occur (as it can be with most health conditions) so blaming yourself for poor adherence to a diet isn’t good for your happiness.

There have recently been challenges to the view that ingestion of yeast containing foods increases the incidence and severity of Candida. Theoretically, it may be that foods which contain yeast are often sources of simple and refined carbohydrates, which if over consumed can negatively affect the immune system and the balance of good and bad bacteria in the digestive system, which act to keep our normal levels of Candida in check.

Crowd Control

Most people are aware of the importance of ‘replacing’ the good bugs after a course of antibiotics to prevent thrush, but what you may not know is that just using a general probiotic may always not do the trick.

After taking a course of antibiotics, a lot of the friendly bacteria that exist in your digestive system are also killed and this can make room for opportunistic organisms such as Candida to grow. In other instances, bacteria such as Clostridium difficile can grow, the culprit for antibiotic associated diarrhea.

Taking probiotics during a course of antibiotics can help to keep the unfriendly bacteria from taking up too much space, but if Candida is a regular occurrence and needs to be treated directly there are some specific strains of probiotics which can be used.

The probiotic strains that have the best research behind their use in supporting vaginal health and reducing Candida are Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Probiotic capsules containing these species can be taken orally as well as occasionally inserted vaginally for best effect. For an over the counter option, I like Blackmores Women’s Flora Balance.

The therapeutic yeast Saccharomyces boulardii, commonly referred to as SB, can also be beneficial in the treatment of thrush.

Yoghurt, in particular Vaalia (because it contains the strain Lactobacillus rhamnosus LGG) when consumed regularly can help reduce the frequency of Candida infections.

Prebiotics are an important tool in keeping your gut flora happy – prebiotics are food for the good bacteria. I’ve written more detail about prebiotics here. Eating a diet rich in prebiotic foods will help with the crowd control, but if needed there are some prebiotic supplements which can be beneficial, such as lactulose. Taken in small doses this syrup can help to feed your good bacteria. Large doses can produce a laxative effect, so start small.

Are you sure it’s Candida?

I have had several patients seek my help for treatment of Candida, only to find that the reason they’re having such a hard time with it is because it’s not actually a Candida albicans infection. It’s definitely worthwhile getting a test from your doctor to confirm what is actually happening – it could be a more stubborn form of Candida such as Candida glabrata, or it could be a different condition which is causing similar symptoms such as lichen sclerosis, bacterial vaginosis, vulvodynia or genital herpes.

Related post: What to do when Thrush and BV don’t go away

Other treatments

If after tweaking your diet and using probiotics, chronic thrush is still a problem, then it may be worthwhile looking at some of the other treatment options available.

Boric acid has been shown to be a highly effective treatment for Candida, including the more stubborn form, Candida glabrata. It is something that can be prescribed by your doctor in the form of a vaginal suppository. Depending on how stubborn the Candida is, it may need to be used anywhere from 3 days to 4 months. The use of boric acid can disrupt the vaginal flora, so probiotic and prebiotic use alongside is a good idea.

Some more natural forms of topical treatment include the use of garlic or tea tree oil which have anti-microbial properties, however while they can be effective at killing Candida they are potentially irritating to the delicate vaginal and vulval tissues.

Herbs which producing soothing, healing effects such as Calendula can be used as a topical wash to help irritated and inflamed tissues. Herbs can be taken internally to support the immune system, and there are some herbs which can also be helpful in killing Candida.

Coconut oil can have a soothing effect topically and also has some anti-candida activity.

The New Zealand herb Horopito can also be helpful in killing Candida, both when taken internally and topically. Kolorex has a range of products containing Horopito but I especially like the Intimate Care cream as a way to reduce discomfort and irritation.

Prevention

These are a few tips to help keep thrush at bay.

• Wee after sex
• Wipe front to back
• Use condoms
• Don’t douche
• Don’t use soap down there
• Wear non synthetic underwear such as cotton or bamboo
• Keep blood sugar levels balanced with a low GI, wholefood diet
• Eat a probiotic rich diet
• Seek alternatives to antibiotics first, and limit use of antibiotics if possible (see a practitioner for help with this)

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Health and Wellbeing Podcast #13 with Guest Kellie Holland from Tonik Health

In the second of two sections on a Naturopathic approach to pregnancy, Kellie Holland from Tonik Health and I chat about some more common issues that pregnant women deal with such as fatigue, urinary tract infections, mood swings, constipation, thrush and heartburn. We also answer some questions such as when to stop lying on your back, and how much caffeine you can have. We also discuss some recommendations for labour and birth preparation including positions, books and courses for birth and raspberry leaf.

Podcast Breakdown: 

0:00 Intro and disclaimer
0:41 Welcome
1:16 Listeria
3:55 Fatigue
5:29 “Eating for two”?
7:57 Urinary tract infections (UTIs)
13:36 Mood swings and stress
15:56 Thyroid issues linked to depression and worsening of menopause symptoms
16:20 Constipation
17:50 Heartburn/reflux
19:05 Thrush/candida
20:24 What to do for coughs and colds in pregnancy?
22:05 Can I drink green tea in pregnancy? (Caffeine)
24:25 When do I have to stop lying on my back during pregnancy?
26:18 Suggestions for preparation for birth and labour and recommended resources and the benefit of having a doula
35:16 Herbs in pregnancy – Raspberry leaf

Click here to subscribe on youtube 

Books mentioned:
Active Birth by Janet Balaskas – http://amzn.to/1OmGCGU
Gentle Birth, Gentle Mothering by Dr Sarah Buckley – http://amzn.to/1LzEmNw
The Natural Way to Better Pregnancy by Francesca Naish – http://amzn.to/1Q983TL
The Natural Way to Better Birth and Bonding by Francesa Naish – http://amzn.to/1OmGMhz

Connect with Kellie

Kellie is a naturopath, clinical nutritionist and medical herbalist based on the Central Coast of NSW where she lives with her husband and daughter. She runs a successful blog on her website at www.tonikhealth.com.au where she also has free healthy and delicious recipes available.

Website: http://www.tonikhealth.com.au/
Facebook: http://www.facebook.com/tonikhealth
Instagram: http://instagram.com/tonik_health#
Twitter: https://twitter.com/tonikhealth

See other videos and podcasts I’ve done with Kellie :

Naturopathic Approach to Pregnancy Part 1

Kid’s Immunity

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The post Naturopathic Approach to Pregnancy (Video) – Part 2 appeared first on Alison Mitchell Naturopath.