In this article:
- The link between menopause and recurrent UTIs
- Effective treatment for menopause-related UTIs
- Comprehensive prevention methods for UTIs during menopause
The constant urge to pee. Burning pain when you expect relief. The dreaded signs of a urinary tract infection. If you’re a woman, you’ve probably experienced a urinary tract infection (UTI), but did you know that many women experience an increase in UTIs as they transition into peri- and post-menopause?
UTIs are extremely common, and they affect both premenopausal and postmenopausal women. However, the likelihood of developing UTIs increases with age, and menopausal women face unique challenges when it comes to fighting off these infections. While 10% of postmenopausal women experience at least one UTI in a single year, recurrent UTIs can affect up to 55% of women after menopause. A recurrent infection is when a person has at least two infections within six months or three or more in a year.
Understanding how UTIs and menopause are linked can empower you to take proactive steps to prevent and manage these uncomfortable infections.
What is a UTI?
Let’s start with the basics. A UTI is a common and often painful condition that occurs when harmful bacteria, most commonly E. coli, enters the urinary tract.
The urinary tract is made up of the bladder, urethra, ureters, and kidneys, and its main function is to eliminate waste and excess fluids from the body. When bacteria, usually from the genital or anal areas, find their way into the urethra, they can multiply and cause an infection.
Why does menopause increase your risk of developing a UTI?
In premenopausal women, UTIs often occur as acute infections, with E.coli bacteria as the cause. Chronic or recurrent UTIs, however, occur more often in postmenopausal women. In fact, recurrent UTIs increase from 26% in premenopausal women to a staggering 55% after menopause. This drastic shift emphasizes the importance of understanding how menopause impacts urinary health.
During perimenopause, estrogen levels fluctuate and decrease. The decline of estrogen impacts the ecosystem of microorganisms living in the urinary tract called the genitourinary microbiome. It also affects the health of the skin inside the bladder wall and the vaginal environment, making you more susceptible to bacterial infections.
The impact of menopause on the urogenital microbiome
Before menopause, the vagina is heavily colonized by "good" bacteria known as Lactobacillus. This helpful bacteria creates an acidic environment that fends off harmful bacteria, including those responsible for UTIs. However, as estrogen levels decline, the cells lining the vagina produce less glycogen—a sugar compound that nourishes Lactobacillus. Consequently, the protective flora in the vaginal environment diminishes, making it easier for infection-causing bacteria to establish a foothold.
Similarly to the vagina, declining estrogen levels during perimenopause can lead to modifications in the lining of the bladder, which can change the urogenital microbiome. This alteration in the microbiome weakens the bladder’s natural defenses against UTIs.
Vaginal, urethral, and bladder changes caused by menopause
As estrogen levels decline during peri- and post-menopause, changes occur in the vaginal walls, known as vaginal atrophy. This condition causes the vaginal walls to become thin, dry, and inflamed, making it easier for bacteria to enter and multiply. The urethra also changes, becoming thinner and shorter, increasing the ease with which bacteria can reach the urinary tract, raising the risk of UTIs.
Your bladder's response is notable too. It becomes less elastic, making it challenging to empty properly. Leftover urine in your bladder is a breeding ground for bacterial growth, leading to more frequent urinary tract infections.
Estrogen is essential for your bladder's health, helping maintain its inner lining. But during menopause, estrogen levels drop, and the bladder's inner lining becomes thin and weakened. With fewer protective cells and less shedding as a result of this atrophy, bacteria can build up inside the bladder, making it more prone to infection.
Another factor contributing to increased UTI risk during menopause is the atrophy of pelvic floor muscles. As estrogen levels decline, these muscles weaken, potentially leading to bladder prolapse—a condition known as cystocele. In cystocele, the bladder drops down, causing urine retention and an environment for bacteria to thrive.
Other risk factors for UTIs during menopause
While menopause itself is a significant risk factor for UTIs, several other factors can further increase your susceptibility to these infections. These include a history of UTIs, diabetes, urinary incontinence, and sexual intercourse, especially for postmenopausal women.
Our caring physicians at FemGevity can help you understand your menopause-related UTI symptoms and provide you with treatment options to help get you back to feeling like yourself again.
How can I get the right treatment for menopause-related UTIs?
While antibiotics are commonly relied upon to manage UTIs, taking a more comprehensive approach to diagnosis and treatment can offer effective relief from UTIs during menopause. Getting the best treatment involves thorough testing to pinpoint the underlying cause of the infection, using antibiotics tailored to the specific type of infection, and implementing preventive strategies to prevent recurring infections.
Comprehensive UTI testing
When dealing with urinary tract infections during menopause, accurate diagnosis is essential for effective treatment and prevention. Here are some key tests to consider:
PCR UTI Testing: If you’re dealing with recurrent UTIs, it may be beneficial to undergo a PCR (Polymerase Chain Reaction) test. This advanced diagnostic tool can accurately detect the presence of UTI-causing microbes, even at low concentrations. Understanding the root cause of your infection will enable your healthcare provider to prescribe the most appropriate antibiotics from the outset, minimizing the risk of unnecessary rounds of treatment.
Vaginal Microbiome Analysis: The vaginal microbiome is crucial in maintaining a healthy urinary tract. Analyzing the vaginal microbiome can provide valuable insights into the balance of beneficial and harmful bacteria. By understanding the unique composition of your vaginal microbiome, you can work with your physician or wellness practitioner to develop tailored preventive strategies.
Overall Health Assessment: Recurrent UTIs can be linked to underlying health conditions such as endocrine disorders like diabetes. Therefore, it’s essential to undergo a full health assessment to rule out any underlying medical conditions that may contribute to UTI recurrence.
Taking a comprehensive approach to UTI diagnosis ensures that treatment and preventive measures are precisely targeted, minimizing the likelihood of recurrent infections and optimizing your long-term health.
Antibiotics for UTIs during menopause
When a UTI occurs, the primary course of action is typically a course of antibiotics prescribed by a healthcare provider. Antibiotics eliminate the harmful bacteria causing the infection, relieve the symptoms, and promote healing. For women with recurrent UTIs, doctors may recommend "prophylactic" antibiotics, meaning taking a dose of antibiotics every time sexual intercourse triggers UTIs.
However, prolonged use of antibiotics, especially for prophylaxis, has potential downsides. Overreliance on antibiotics contributes to the growing concern of antibiotic resistance in bacterial infections. Postmenopausal women may also have higher resistance rates to certain antibiotics.
What can I do to prevent UTIs during menopause?
While antibiotics are important for treating UTIs, there may be better long-term solutions, especially if you experience frequent infections. The good news is that there are proactive steps you can take to prevent UTIs during menopause and reduce your reliance on antibiotics.
Menopause Hormone Therapy (MHT)
Menopause hormone therapy is a highly effective treatment for managing genitourinary symptoms of menopause (GSM), which includes conditions that may predispose women to UTIs. FemGevity offers FDA-approved, plant-based bioidentical estradiol as part of MHT to supplement declining estrogen levels naturally.
Estradiol Vaginal Cream
Vaginal estrogen therapy is an option many menopausal women explore to combat the spread of bacteria and soothe hormonal-induced skin irritations. Studies show that vaginal estrogen is particularly effective in reducing recurrent UTIs compared to oral estrogen. This therapy involves using a topical cream, tablet, insert, or insertable ring that slowly administers a low dose of estrogen directly to the vagina.
FDA-Approved Vaginal Medications
Alongside vaginal estrogen therapy, FDA-approved vaginal medications containing DHEA (dehydroepiandrosterone) and ospemifene (a Selective Estrogen Receptor Modulator) work similarly to estrogen, enhancing the condition of vaginal tissue to prevent UTIs linked to vulvovaginal atrophy.
Probiotics are live microbe supplements that can help you restore and maintain a healthy vaginal microbiome. When choosing a probiotic, look for specific microbial strains, live organisms, adequate CFU count, and the option for vaginal insertion, tailoring it to your UTI prevention plan.
Smart lifestyle modifications
Incorporating lifestyle and hygiene changes into your daily routine can also significantly reduce the risk of UTIs during menopause. Here are some helpful tips:
- Urinate before and after sex
- Try not to strain when you pee. Stay relaxed and empty your bladder completely so no urine is left over.
- Use silicone-based lubricants
- Wipe from front to back
- Stay hydrated
- Explore dietary supplements, including D-mannose, cranberry extract, and vitamin D3
Living UTI-free during menopause
Empowering yourself to take control of your urinary health can help you embrace this transformative phase of your life with fewer disruptive symptoms. Remember, discussing tailored prevention strategies with your healthcare provider is crucial for optimizing UTI prevention and your overall health during menopause. At FemGevity, we can help you get the right treatment to help prevent UTIs from holding you back during menopause and beyond.
Chen YY, Su TH, Lau HH. “Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials.” Int Urogynecol J. 2021 Jan;32(1):17-25. doi: 10.1007/s00192-020-04397-z. Epub 2020 Jun 20. PMID: 32564121.
Jung C, Brubaker L. “The etiology and management of recurrent urinary tract infections in postmenopausal women.” Climacteric. 2019;22(3):242-249. doi:10.1080/13697137.2018.1551871
Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010 Jan;85(1):87-94. doi: 10.4065/mcp.2009.0413. PMID: 20042564; PMCID: PMC2800285.
Alperin M, Burnett L, Lukacz E, Brubaker L. The mysteries of menopause and urogynecologic health: clinical and scientific gaps. Menopause. 2019 Jan;26(1):103-111. doi: 10.1097/GME.0000000000001209. PMID: 30300297; PMCID: PMC6376984.
Goldstein I, Dicks B, Kim NN, Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med. 2013 Dec;1(2):44-53. doi: 10.1002/sm2.17. PMID: 25356287; PMCID: PMC4184497.
Miotla P, Romanek-Piva K, Bogusiewicz M, Markut-Miotla E, Adamiak A, Wróbel A, Zebrowska M, Wawrysiuk S, Mendyk K, Rechberger E, Jakubczak A, Rechberger T. Antimicrobial Resistance Patterns in Women with Positive Urine Culture: Does Menopausal Status Make a Significant Difference? Biomed Res Int. 2017;2017:4192908. doi: 10.1155/2017/4192908. Epub 2017 Apr 13. PMID: 28497048; PMCID: PMC5406742.
Geng L, Huang W, Jiang S, Zheng Y, Zhou Y, Zhou Y, Hu J, Li P, Tao M. Effect of Menopausal Hormone Therapy on the Vaginal Microbiota and Genitourinary Syndrome of Menopause in Chinese Menopausal Women. Front Microbiol. 2020 Nov 20;11:590877. doi: 10.3389/fmicb.2020.590877. PMID: 33329470; PMCID: PMC7718012.
Chen YY, Su TH, Lau HH. Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials. Int Urogynecol J. 2021 Jan;32(1):17-25. doi: 10.1007/s00192-020-04397-z. Epub 2020 Jun 20. PMID: 32564121.