What are UTIs and why do they occur more after menopause?

Did you know that urinary tract infections (UTIs) often tend to increase in frequency during menopause due to hormonal changes affecting the urinary system? This can be distressing, but there is hope for relief. Fortunately, besides relying solely on hygiene practices and antibiotics, there are various practical strategies available to prevent and manage chronic UTIs effectively.

By exploring these options, you can address UTIs before they escalate into recurrent or chronic conditions, reducing the potential stress they may bring to your daily life.

What causes a UTI?

A UTI may occur after bacteria enters the urethra and travels up the bladder. It can happen at any time in life for both men and women, though women get them more often because their urethras are shorter and closer to the rectum, where bacteria may reside.

Individuals progressing through menopause experience high rates of ongoing and recurrent UTIs due to the physical and hormonal changes that occur during menopause. [1]

During menopause, the body stops producing as much estrogen, which plays a key role in keeping vaginal tissues healthy. As estrogen levels lower, vaginal tissue thins and becomes more fragile, leading to:

• Increased infections
• Vaginal dryness
• Pain with intimacy and sex
• Frequent urination

It can be difficult for women to notice they may have a UTI, or that one has cleared up after treatment, because so many of the symptoms overlap with menopause. These include:

• Frequent urination
• Pain with intimacy and sex
• Pain and burning while peeing
• Fever
• Abdominal, pelvic, or back pain

How are UTIs typically treated?

UTIs are typically treated with prescription antibiotics. If you are prone to getting UTIs, a doctor will offer well-intentioned preventative lifestyle/hygiene advice such as:

• Stay hydrated
• Pee after sex
• Try supplements, such as cranberry and D-mannose
• Wipe front to back after using the bathroom
• Avoid wearing tight, restrictive underwear

While these recommendations might lower the risk of UTI, they don’t work for everyone, especially if the underlying cause isn’t being addressed. [2]

Treating the underlying cause of recurrent UTIs

Roughly 25% of women struggle with recurrent UTI, even if they do their best to prevent and treat infections. A recurrent infection is defined as having three or more UTIs in a given year, or two or more in six months. [3]Treating the underlying cause of infection can help lower how many UTIs a woman gets, especially in those who are past menopause.

Studies have shown that vaginal estrogen therapy prevents UTI recurrence in half of all women who live with repeat UTI. [4,5] Vaginal estrogen is a cream, tablet, or ring that is inserted into the vagina.Vaginal estrogen therapy may be an option as well for those who are premenopausal and experiencing recurrent UTIrtain medications, breastfeeding, and other lifestyle factors can affect estrogen levels. [6]

Vaginal estrogen therapy isn’t the only treatment that may get at the root cause of recurrent UTI. Depending on a woman’s symptoms and history, there are other options and risk factors her doctor might explore.

Other considerations for recurrent UTI

For those with undiagnosed or untreated type 2 diabetes, treatment to stabilize blood sugars and improve metabolic health can help lower occurrences of UTI. [7]

Doctors might order imaging to identify if there’s a structural or anatomical reason for why a woman is getting UTIs more frequently. [8] These reasons could include:

• Infected cysts
• Kidney or bladder abscesses
• Calculi buildup (e.g., stones)

If you’re experiencing recurrent UTIs and can’t identify how or why, your doctor might suggest one or more of the following scans:

• Ultrasound: a painless imaging test that helps your doctor look at your organs
• ‍CT scan: another painless imaging test, similar to an X-ray, that takes pictures of your organs, blood vessels, and soft tissues to give a more detailed view than an ultrasound‍
• Cystoscopy: a short test that involves inserting a small camera with a light on the end into the urethra and up to the bladder

The impact of living with chronic UTI

Some women are just prone to more UTIs no matter what measures they take. This can be due to genes, structural issues, or something else not brought on by hygiene or lifestyle behaviors.

However, a lot of health messaging suggests that simply staying hydrated and practicing good hygiene can stave off UTIs, which makes it difficult for women to speak with their doctor about their experiences without feeling as if they are being dismissed or “blamed” for chronic infection cycles. [9]

Feelings of embarrassment, shame, and frustration can sometimes override an opportunity to have an honest conversation with a doctor around treatment, preventative measures, and ultimately, a better quality of life.

Finding a doctor that will listen to you and take your concerns seriously is essential. After all, UTIs impact quality of life in the form of impairing sleep, work productivity, exercise, sex, and social activities.

Starting the conversation with your doctor

If you’ve had recurrent UTIs, you likely see how they negatively affect your life. Speaking with your doctor about what you’re experiencing and how it’s impacting you each day can put you on the right path for developing a plan to prevent and reduce UTI.

Here are some tips for speaking with your doctor (Tip: think about writing these down and bringing them with you to your appointment):

• Share how many UTIs you’ve had over the last year, and if they’ve been chronic over the course of your lifetime.
• Discuss your lifestyle/hygiene habits and let your doctor know you take action to prevent UTIs.
• Tell your doctor exactly how this impacts your quality of life (e.g., poor sleep, trouble focusing, needing to always stay close to a bathroom, etc.).
• Ask if you could benefit from imaging tests. Be specific and inquire about an ultrasound, CT scan, and cystoscopy.
• Ask if you’re a candidate for vaginal estrogen therapy. Discuss the pros and cons.
• Consider rehearsing how you’ll say these things to your doctor in front of the mirror or in front of someone you trust before your appointment. Practice can build confidence and help make sure you don’t forget anything.

In short, there are steps you can take—including making time for a comprehensive discussion with your doctor— to make recurrent UTIs one less thing to worry about during menopause, and beyond.