Management of postmenopausal chronic vulvovaginitis caused by Candida and related species

Vulvovaginitis caused by Candida and related species is uncommon in postmenopausal patients; however, chronic vulvovaginitis caused by Candida and related species can occur in postmenopausal patients using oral or topical estrogen as hormone replacement therapy (HRT). Examine the patient (see Assessment of vulvovaginitis caused by Candida and related species in adults) and trial stopping HRT. Consider referring the patient to a gynaecologist or dermatologist for further investigation and to confirm diagnosis. The patient may be able to restart HRT at a lower dose once the vulvovaginitis resolves. If it recurs, options are to stop HRT permanently, or to continue HRT and use intermittent antifungal therapy.