Premenstrual Recurrent Vulvovaginal Candidiasis: Case Study and Narrative Review on Hormonal Influences and Clinical Implications

Recurrent vulvovaginal candidiasis (RVVC) affects up to 9% of women with more than three episodes annually, often exacerbated by hormonal fluctuations in the luteal phase of the menstrual cycle, causing significant impacts on physical, emotional, sexual, and social quality of life; this article conducts a literature review on the epidemiology, pathophysiology, hormonal influence, clinical manifestations, and diagnosis of premenstrual RVVC, complemented by a case study to highlight diagnostic and therapeutic challenges. A literature review was performed using sources such as scientific articles, reviews, and guidelines on Candida spp., vaginal dysbiosis, the role of estrogen and progesterone, and risk factors, allied to the chronological report of a 19-year-old patient with recurrent premenstrual symptoms, evaluated through anamnesis, gynecological examination, microscopy, and laboratory tests, with initial antifungal treatments and contraceptive adjustment. The review identified that estrogen promotes fungal adhesion, biofilms, and vaginal alkalization, while progesterone modulates immunity, aggravating recurrences; in the case, symptoms such as pruritus, discharge, and erythema persisted despite fluconazole and topicals but resolved after replacing oral contraceptive with etonogestrel subdermal implant, without evidence of fungal resistance. PM-RVVC requires differential diagnosis to exclude conditions like cytolytic vaginosis, avoiding self-medication and resistance; personalized approaches considering hormonal influences improve clinical management, reinforcing the need for standardized protocols and public health education.