Menopause and UTIs: What’s the Link?

If there’s one thing all people with vaginas can relate to, regardless of age, it’s that urinary tract infections (UTIs) are the worst thing ever. And if you’re currently going through menopause, you might know firsthand that, unfortunately, urinary tract infections are a lot more common in menopause. 

Urinary tract infections can affect your bladder (this is called cystitis), urethra (urethritis), or kidneys (pyelonephritis). They’re primarily caused by bacteria entering your urinary tract. 

Sex is often to blame for urinary tract infections in younger women but in perimenopause and menopause, the culprits can also be hormonal and physical changes such as lower levels of the hormone estrogen, thinning of the vaginal tissue, and incontinence. Urinary symptoms are a common aspect of the genitourinary syndrome of menopause (GSM).

Let’s explore the connection between menopause and UTIs, and what you can do to protect your urinary health.

Menopause and UTIs

Menopause is a natural phase in a woman’s life, typically occurring between the ages of 45 and 55, when the ovaries gradually reduce their production of hormones like estrogen and progesterone. This decline in hormone levels leads to the end of menstruation and various changes in the body, including the urinary tract.

There are two main reasons why menopause increases your risk of UTIs: changes to your vaginal microbiome and issues with the pelvic floor. Both are the result of decreasing levels of estrogen.

How menopause affects the vaginal microbiome 

Estrogen plays a very important role in the vaginal microbiome. Estrogen causes changes in the vagina that allows protective bacteria like Lactobacilli to thrive. Specifically, it helps your body produce glycogen — a food source for beneficial bacteria called Lactobacilli. These bacteria keep vaginal pH acidic and prevent the overgrowth of potential pathogens like E. coli.

In perimenopause (the phase leading up to menopause), estrogen levels start declining. This also means that food for Lactobacilli decreases, so their numbers start to decline. 

The balance of good bacteria in the vagina can shift due to lower estrogen levels. These bacteria help prevent harmful bacteria from multiplying, so their reduction can lead to an increased risk of UTIs. 

Estrogen also plays a crucial role in maintaining the health of the urinary system, particularly the bladder and urethra. It helps keep the tissues of the urinary tract thick and elastic and supports the balance of healthy bacteria in the vagina, which protects against infections. With less estrogen, the lining of the urethra (the tube that carries urine out of the body) becomes thinner and more fragile, making it easier for bacteria to enter and cause infection.

How menopause affects the pelvic floor

Your pelvic floor acts like a sling that supports your uterus, bladder, urethra, and bowels to help them function efficiently. But a weak pelvic floor can cause bladder prolapse, where the bladder drops and bulges into the vaginal wall. 

Over time, and particularly during menopause, the muscles that support the bladder and urethra may weaken, potentially leading to incomplete bladder emptying. When urine remains in the bladder, it provides an environment where bacteria can thrive, increasing the risk of infection.

Menopause can also cause vaginal dryness, which might extend to the urethra, leading to discomfort and irritation that can facilitate bacterial infections.

What are the signs of a UTI? 

UTI symptoms are generally the same, whether you're menopausal or not. Common symptoms of a urinary tract infection include: 

• Discomfort, stinging, or burning when you pee 
• A frequent, sudden need to pee 
• A constant feeling that you need to pass urine, even when your bladder is empty
• Pain in your lower abdomen
• Strong-smelling urine
• Cloudy urine that may have blood in it
• a high temperature. 

How to prevent UTIs in menopause  

Aside from the classic preventative methods — drink plenty of water, wipe front to back, pee after sex — you can further help to reduce the chance of getting a urinary tract infection in menopause with a few more solutions: 

• Talk to your doctor about vaginal estrogen. Adding estrogen back into the vagina helps restore and strengthen the lining of the vagina and may help manage symptoms like vaginal dryness and UTIs. It can also help restore the protective vaginal microbiome by restoring the food source for Lactobacillus. This will help keep the pH low and healthy (something that moisturizers and lube don’t do). 
• Keep your genital area clean and dry. If you use incontinence pads, remember to change them regularly to prevent bacteria from entering your urinary tract. 
• Limit your intake of bladder irritants like caffeine and alcohol. 
• Take a D-mannose supplement. Some evidence suggests that D-mannose may help prevent chronic UTIs. 
• Strengthen your pelvic floor to reduce your risk of prolapse. You can do pelvic floor exercises at home or with the help of a pelvic floor physiotherapist.  

If you’re experiencing frequent UTIs or symptoms that don’t improve with antibiotic treatment, it’s important to see your healthcare provider. They can help identify any underlying issues and recommend appropriate treatments, which may include antibiotics, lifestyle changes, or hormone therapy.

If you're curious about what's happening in your vaginal microbiome, you can try testing it with Evvy's Vaginal Health Test. It's a quick, 30-second, at-home swab that will tell you all the protective and disruptive bacteria and fungi in your vaginal microbiome. This includes measuring the percentage of protective Lactobacilli in your vaginal microbiome, which can help you understand if menopause could be affecting your vaginal health.

FAQ

Can menopause cause urinary tract infections?

Menopause won't directly cause a urinary tract infection, but it can increase your risk of developing one. This is primarily due to the decline in estrogen levels that happens during menopause, which leads to thinning and weakening of the urinary tract tissues, as well as changes in the vaginal flora. Estrogen helps maintain the health of the bladder and urethra, and its reduction makes the urinary tract more susceptible to infections. Additionally, vaginal dryness and weakened pelvic floor muscles during menopause can contribute to incomplete bladder emptying, creating an environment where bacteria can thrive, further raising the risk of UTIs.

What is the best treatment for UTIs in menopause?

The best way to treat urinary tract infections during menopause is by combining different approaches to tackle both the infection and the underlying factors that contribute to the increased risk. Antibiotics are used to clear the infection, but to prevent future UTIs, we also need to address the hormonal changes of menopause. Using low-dose vaginal estrogen therapy, available as creams, rings, or tablets, can help to restore the health of the vaginal and urinary tissues, lowering the chances of getting infections. Additionally, staying well-hydrated, practicing good hygiene, urinating after sex, and possibly incorporating probiotics into your diet can also help prevent future UTIs. Remember, it's essential to work with your healthcare provider to figure out the best treatment plan for your specific needs.