Natural treatment for thrush during pregnancy

natural-treatment-thrush-pregnancy

Vaginal Candidiasis is commonly called thrush, or a yeast infection. It is caused by the overgrowth of a fungus called Candida, leading to a characteristic white, cottage cheese-like discharge, and/or itchiness. Candida is part of the usual flora of the vagina, along with half a dozen other types of bacteria. Together, they maintain the pH of the vagina at less than 4.5. To put this into context, lemons have a pH of about 2. The acidic environment in the vagina protects you from being infected by an overgrowth of organisms you don’t like, of which Candida is one.

Why is thrush more common in pregnancy?

Thrush occurs when there is a change in the bacteria of the vagina (the most prominent of which is lactobacilli), making the pH in the vagina more alkaline. This change commonly occurs due to the hormonal influences of pregnancy. Oestrogen works on the cells of the vagina, keeping mucosa active, and encouraging the production of glycogen.

Lactobacilli use glycogen as an energy source to make their own excretion – hydrogen peroxide (yep, like the hair colour), and it is this hydrogen peroxide that keeps the vagina acidic, allowing the presence of good bacteria and remaining hostile to other organisms. Hyperestrogenic states – where you have more oestrogen than usual – occur in pregnancy. However, Candida also feeds on glycogen so if the balance is off, Candida can overgrow.

Having thrush when you are pregnant won’t harm your baby. However, it can be distressing to live with, causing itching, which in turn cases inflammation, redness and sometimes splits or fissures of the skin from scratching if it has been going on a long time. It can be very uncomfortable and affect your daily activities, causing it to burn when you urinate or causing discomfort during sex.

The only effective scientifically proven treatment for vaginal candidiasis is an anti-fungal medication called clotrimazole, which is entirely safe to use in pregnancy.

The only effective scientifically proven treatment for vaginal candidiasis is an anti-fungal medication called clotrimazole, which is the active ingredient in Canestan pessaries and cream, and is entirely safe to use in pregnancy.1 It works by stopping the production of essential components in the fungus cell membrane, inhibiting its growth. You should visit your GP to confirm you have thrush, and they may advise you to get Canestan, which is available over the counter in pharmacies.

There is an oral tablet treatment for vaginal candidiasis called fluconazole, however it is not advisable for use in pregnancy. This is because there have been cases of birth defects when high doses of fluconazole have been used. However if someone has taken a single low dose, ie. a 150mg dose which is the standard treatment for resistant thrush, they shouldn’t worry as this amount is unlikely to cause any defect. Nonetheless, it should be avoided if you know you are pregnant.

If my thrush won’t go away with treatment, could it be something else?

If your thrush doesn’t respond to two courses of treatment, the National Institute of Clinical Excellence advises consideration of other causes. For example, your infection may be caused by a different species of Candida (the majority of yeast infections are caused by Candida albicans). Or, you may have bacterial vaginosis as opposed to a fungal infection. It could even be trichomonas vaginalis, a sexually transmitted disease.2 These can all be tested for by your doctor. Any vaginal infection can make you at risk of preterm rupture of membranes or preterm delivery, so you should go to the doctor if you are experiencing any symptoms which you believe could be thrush or aren’t sure what they are.

Are home remedies ever useful or advised?

Home remedies and natural treatments for thrush abound, but very few have been scientifically assessed or proven to be effective. Almost all come with a warning not to use when pregnant. Below is a list of options you can commonly find, along with why they are thought to work, and what evidence, if any, there is to back up that claim.

Yoghurt

Yoghurt may actually work, or rather, no studies have shown it to do any harm, at least.3 However, that being said, no large scale studies have been done, and the small ones that have been conducted, no significant benefit was found.4

However, since the issue with candida overgrowth comes from a lactobacilli imbalance and these probiotic bacteria are present in live yoghurt it is possible that eating it, or applying it either topically or intra-vaginally may not do any harm. The advice formally is: applying yoghurt intravaginally may be embarrassing and uncomfortable. However, different yoghurts can be purchased, their compositions vary and their effects may differ. The effect of alterations in vaginal pH that may occur with intravaginal yoghurt use is unknown.5

Tea tree oil

Tea tree oil is advocated because it is an essential oil with anti-bacterial and anti-fungal properties. A British Medical Journal review of clinical evidence did not identify any large scale trials looking at the efficacy of this as a treatment compared to other treatments. It did find a summary of a lot of little trials which concluded that tea tree oil can cause skin irritation and a severe allergic rash.6 One worrying case report found applying tea tree oil was associated with a systemic hypersensitivity reaction.7

Thrush is a common problem in pregnancy, and concerns about medications being safe to use are very real. Your doctor will never knowingly give you a medication that has not been extensively tested to prove its safety in pregnancy – and that’s important.

Expert opinion found from the Faculty of Sexual a Reproductive Health and British Association of Sexual Health as well as the Royal College of General Practitioners is that there is currently insufficient evidence to recommend the use of tea tree oil in the management of vulvovaginal candidiasis.8

Other alternative treatments

Oil of oregano also claims to be anti-fungal, and women are advised to put some drops of it into coconut oil and then soak a tampon in it before inserting. However, there is no scientific evidence that this works.

Coconut oil is often recommended, either on its own or as a transporter for the above oils. It is said to be anti fungal. As a transporter it provides emollience or a moisturising cover for the mucosa so it would hopefully make them burn – less. Are there any studies to prove its effectiveness in people? No.

Vaginal douching is sometimes recommended because it is said to “clean your vagina”. But the vagina is self-cleaning, so don’t do it. In fact, studies have shown that douching increases your risk of Candida infection.9

Apple cider vinegar is touted as a thrush cure, either ingested or used to bathe in. While the vinegar has been found to kill fungi in a petri dish, no studies have shown it to have the same effect in people.

Garlic is another product that has antibacterial and possibly anti-fungal properties. However, placing it on sensitive vaginal skin by inserting it with a tampon or threading a string through it and placing it in the vagina is not a good idea. Not only can it cause a significant burning sensation, it can also get stuck – and rot.

If in doubt, ask your doctor

Thrush is a common problem in pregnancy, and concerns about medications being safe to use are very real. Your doctor will never knowingly give you a medication that has not been extensively tested to prove its safety in pregnancy – and that’s important.

The temptation to try a natural solution makes sense, as thrush can be so distressing. Healthy eating and lifestyle changes for the bedrock of medical advice. But in our eagerness to pursue non pharmacological treatments to real clinical problems we can forget that many medications actually do come from the natural world (think of aspirin from tree bark or certain chemotherapy agents from sea sponges, to name just two).

The bottom line is anything invasive (being put inside your body), especially in pregnancy, should have some sort of testing and evidence before use, so, even if you are desperate, go and discuss the best treatment for you with your doctor.

Disclaimer: This content is designed to provide general information and is not a substitute for medical advice. Medical opinion, practice and routine may vary from country to country and may change from time to time. The author is not liable for the results of misuse or inappropriate application of the information. If you are an individual who chooses to access this information, you should not rely on the information as professional medical advice or use it to replace any relationship with your doctor or other qualified healthcare or social care professional. For medical concerns, including decisions about medications and other treatments, individuals should always consult their doctor or, in serious cases, seek immediate assistance from emergency personnel. Individuals with any type of medical condition are specifically cautioned to seek professional medical advice before beginning any sort of health treatment. Individuals with specific queries or concerns should seek appropriately qualified medical advice. Clinicians must use their own judgement when interpreting this information and deciding how best to apply it to the treatment of patients.

References

  1. NICE, ‘Clotrimazole’, BNF, [website], https://bnf.nice.org.uk/drug/clotrimazole.html, (accessed 3 October 2018).
  2. NICE, ‘Candida female genital’, Clinical Knowledge Summaries, National Institute for Health and Clinical Excellence, 2017, [available online], https://cks.nice.org.uk/candida-female-genital, (accessed 3 October 2018).
  3. J. Lopez, ‘Candidiasis (vulvovaginal)’ BMJ Clinical Evidence, 2015.
  4. Ibid.
  5. Ibid.
  6. NICE, ‘Candida female genital’, 2017, https://cks.nice.org.uk/candida-female-genital, (accessed 16 October 2018).
  7. Ibid.
  8. Dr. N Lazaro, ‘Sexually Transmitted Infections in Primary Care’, RCGP and BASHH Guidelines, [available online], 2013, http://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/sexually-transmitted-infections-in-primary-care, (accessed 16 October 2018).
  9. J. Lopez, ‘Candidiasis (vulvovaginal)’, 2015.

Dr. Natasha Abdul Aziz

Natasha is senior clinical fellow in Obstetrics & Gynaecology with the Chelsea & Westminster NHS foundation trust. She was previously a clinical research fellow at the University of Oxford and national women’s health lead for the Muslim Doctors Association of the UK. Her special interests include the use of digital healthcare solutions to help vulnerable populations of women, volunteer work with refugees, and chasing that last sliver of sun on her balcony after work.

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