Women's Health

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Recurring Nightmare

My 16-year-old daughter suffers from recurrent yeast infections, I've been buying her Monistat, which seems to stop the infection, but then she gets another one within a few weeks. What can she do to stop this cycle?

Not everything that causes itching, burning, or redness is a yeast infection. I am assuming that you have had a health care professional confirm that these episodes really are due to yeast, and not to another infection like bacterial vaginosis. Additionally, chemical irritation from soap, detergent, bubble bath, or just about anything that comes in contact with the vulvar or vaginal area can cause an irritation that can be mistaken for a yeast infection.

If it is in fact a yeast infection, there are a number of things that may be causing it to recur. First, although Candida albicans is the most common cause of yeast infection, other kinds of Candida can also cause the problem. Over-the-counter yeast medications won't kill the other species of Candida, but there are prescription drugs that can.

Three other factors that can contribute to chronic yeast infections are (1) sex: Semen can overcome the vagina's natural acidity temporarily (it has to, because otherwise the sperm would be killed), so if your daughter is sexually active she should use condoms (and not just for this reason): (2) synthetic fibers: Nylon or polyester underpants, pantyhose, tight synthetic pants, and panty liners all create a humid environment where moisture can't escape, which can encourage the growth of yeast in the vagina; and (3) underlying disease: Both diabetes and HIV infection can predispose a woman to chronic yeast infections, so a blood sugar test and an HIV test (if appropriate) may be in order.

The vagina is a complex ecosystem. Although Candida is a normal part of vaginal flora, it can overgrow and cause itching, burning, redness, and/or a cottage cheeselike discharge. One of the ways the vagina keeps Candida and other unwanted flora in check is through beneficial microorganisms. As in other aspects of our lives, balance is key here. Lactobacilli, beneficial bacteria that secrete lactic acid and are normally present in the vagina and elsewhere in the body, help to preserve the natural acidity of the vagina. Additionally, some strains of Lactobacillus secrete hydrogen peroxide, which also helps to control unwanted flora and may even decrease the rate of transmission of sexually transmitted infections. Not every woman is colonized with lactobacilli (and even those who are don't necessarily have the super-efficient variety that produces hydrogen peroxide). Women who are not colonized are more likely to get bacterial infections.

Eating yogurt can help with this balance. A D92 study that appeared in the Annals of Internal Medicine monitored the effect of yogurt on yeast infections. The plan was for 33 women with recurrent candidal vaginitis to eat a diet that included yogurt for six months and then a yogurt-free diet for six months. But it didn't go as planned because eight of the women got so much relief with the yogurt that they refused to switch to the yogurt-free diet. Analysis of the women who did follow the plan showed a threefold decrease in Candida infections during the six months they ate yogurt.

Several researchers are working on vaginal suppositories containing lactobacilli. These "vaginal vitamins" may be on the market in the next few years. An uncontrolled study of 28 women with recurrent vaginal candidiasis published in the Journal of Clinical Microbiology found subjective improvement after seven days of using vaginal suppositories containing Lactobacillus casei. Indeed, some women report relief from yogurt applied vaginally.

So the first thing I would have your daughter try is eating yogurt with live cultures daily. I would also recommend she insert lactobacilli vaginally. Buy some capsules at the health food store (the ones that are refrigerated are more likely to be alive). Every evening have her empty two capsules and mix them into a paste with water. It's easiest to insert this with a finger.

Help for Hair Loss

Ever since I entered menopause, I've been losing more hair than usual. I've always had thick hair so most people don't notice, but I do. Is there anything I can do to make my hair thick again--or at least prevent more from falling out?

There are different kinds of hair loss in women. General thinning or hair loss all over the head can result from low estrogen levels, high androgen levels, stress, pregnancy (not an issue in your case), and metabolic problems, especially with the thyroid gland. Patchy loss of hair may be due to bacterial or fungal infection; small, circular bald patches are called "alopecia areata" and appear to be an autoimmune disorder.

Different causes have different treatments. In your case it's probably related to lower estrogen levels, but it's worth having a few blood tests to check your androgen levels and thyroid function. If the only cause seems to be low estrogen, hormone therapy may be helpful. (But sometimes higher-than-usual doses are needed; you may want to think carefully about this option because hormone replacement therapy is not risk-free. For example, it may increase breast cancer risk.) Although there's no evidence that increasing your intake of phytoestrogens (from soy products and flaxseed) will help this condition, it may be worth a try.