Urinary tract infection and menopause
Menopause is a transformative period in a woman's life, but it comes with challenges. Urinary tract infections (UTIs), such as bladder infection, is one of them. Women going through menopause and postmenopause are more prone to UTIs. Why is that? And what can you do about this?
I stopped having periods two years ago. Since then, I keep getting bladder infections. It’s a pain, literally. Is there anything I can do to prevent them? - Marion (age 47)
Women are more prone to UTIs than men, in particular after menopause. In perimenopause, 36 percent of women suffer from recurrent UTIs. This percentage increases to 55 in postmenopause. UTIs are even more common in women over the age of 65.
Changing hormone levels during menopause can also cause a host of other symptoms, such as vaginal dryness, decreased sex drive and skin ageing. Most women in menopause experience three or more symptoms.
What is happening in your body?
Bladder infection (cystitis) happens when bacteria, often from the skin or rectum, enter the urethra, and infect the wall of the bladder. Because women have a much shorter urethra than men, they are far more susceptible to bladder infection.
As your oestrogen levels decrease during menopause, your susceptibility increases. Oestrogen keeps tissues and mucous membranes in the vagina and urethra moist and muscles strong. When oestrogen levels fall, these tissues become thinner, drier and less acidic, and the muscles of the urinary tract weaker, making it easier for bacteria to enter the bladder through the vagina and urethra. This can result in bladder infections.
In addition, a balanced oestrogen level helps keep the healthy bacteria in the vagina and bladder balanced. These bacteria protect against infections. Low oestrogen reduces the amount of healthy bacteria, making you more susceptible to infection, and it can also cause the pelvic floor to collapse.
Bladder infection and the pelvic floor
Oestrogen stimulates the production of collagen, which keeps pelvic floor muscles (and muscles and joints in general) strong and elastic. Less oestrogen means less collagen and elastin are produced, causing the pelvic floor to weaken and the bladder to drop down (pelvic organ prolapse). As a result, your bladder sometimes may not empty fully when you go to the toilet. The urine left behind can become prone to infection.
How can you tell if you have a UTI?
Urinary tract infection symptoms most commonly cause problems such as:
- Pain or burning sensation when passing urine
- Increased need to urinate
- Need to urinate even though the bladder is empty
- Cloudy urine or urine with an unusual odour
- Bloody urine
- Lower abdominal discomfort or groin pain
- Fever and/or night sweats
What can you do to prevent UTIs?
There is no way to avoid menopause. However, this doesn’t mean you have to live with recurrent UTIs and their symptoms. You can prevent them by changing your lifestyle.
- Drink a lot of water. At least two to three litres a day. Drinking water helps flush out bacteria from your urinary tract and helps prevent infection. A study was conducted where every day, one group of menopausal women drank their usual amount of fluids plus an additional 1.5 litres of water, while another group drank just their usual amount of fluids. The results showed that the women who drank an additional 1.5 litres of water had fewer episodes of recurrent bladder infection.
- Improve gut health. The gut microbiome can affect urinary tract health. Research has shown than having a large amount of good bacteria in the gut can reduce the risk of bladder infection. Foods that are high in probiotics (e.g., kimchi, sauerkraut, yoghurt and kefir) and prebiotics (e.g., wheat bran, whole grain products, vegetables and fruit) support your intestinal flora. Eat slowly and chew well. This will help your body to absorb the nutrients.
- Avoid foods that irritate the gut. Certain foods, such as acidic foods, may promote inflammation. Avoid acidifying foods, such as coffee, alcohol, soy, sugars and fast carbohydrates, cheese and meat.
- Take a shower instead of a bath. The presence of soap and shampoo in the bath water makes it easier for water and germs to enter the vagina and urinary tract.
- Avoid using soap and intimate hygiene products. You should wash your vulva with warm water. You don't need to use soap.
- Urinate after sex. During sex, bacteria can enter your urethra, raising your chances of getting an infection. Peeing after sex may help to flush bacteria out of the urethra, thereby helping to prevent a UTI. Tip: drinking a large glass of water makes it easier to urinate.
- Consider taking a D-mannose supplement. Research has shown that D-mannose works to treat or prevent UTIs. D-mannose is a kind of sugar that is related to glucose. It's found in small amounts in foods such as lentils, berries, pineapple and mushrooms. Taking a D-mannose supplement can also provide effective urinary support.
Medication for UTIs
Do you suffer from recurrent UTIs? Antibiotics will relieve your symptoms within a few days.
What treatment is right for you?
If you have an UTI, you’ll be prescribed an antibiotic to treat the infection. Antibiotics kill harmful bacteria, but they don't address the root cause of the problem. What’s more, the more often you use antibiotics, the greater the risk that bacteria will become resistant, making new infections more likely. Therefore, you should also focus on adopting a healthy lifestyle.
Antibiotics for UTIs
Doxazosin belongs to the group of medicines called vasodilatants (alpha blockers). It is used to help relax the muscles in the opening of the bladder. This may help increase the flow of urine and/or decrease symptoms. Doxazosin is also used to treat conditions such as high blood pressure (hypertension). It works by widening the blood vessels, making it easier for the heart to pump blood around the body.
I keep getting bladder infections and it's driving me mad! Taking antibiotics helps. So does drinking water and peeing after sex. - Claire (age 45)
Can hormone therapy help?
Hormone replacement therapy (HRT) can be an option for women with severe menopausal symptoms. HRT treats these symptoms by replacing the hormones that your body produces less of as you go through menopause. It can be prescribed to women experiencing symptoms such as hot flashes, sleep problems, vaginal dryness and mental health symptoms. Do you have any of these symptoms as well as UTIs? Then HRT might be an option for you.
Sources
- Dr. Cichowski SB. American College of Obstetricians and Gynecologists. (2023). UTIs After Menopause: Why They’re Common and What to Do About Them. https://www.acog.org/womens-health/experts-and-stories/the-latest/utis-after-menopause-why-theyre-common-and-what-to-do-about-them
- Centers for Disease Control and Prevention. (2021). Urinary Tract Infection. https://www.cdc.gov/nhsn/ltc/uti/index.html
- UT Southwestern Medical Center. (2019). Study sheds new light on urinary tract infections in postmenopausal women https://www.sciencedaily.com/releases/2019/05/190511083926.htm
- Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, Lotan Y. (2018). Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. PMID: 30285042.
- National Association for Continence. Improve Your Gut, Reduce Your Bladder Leaks? https://nafc.org/bhealth-blog/improve-your-gut-reduce-your-bladder-leaks/
- Graziani C, Laterza L, Talocco C, Pizzoferrato M, Di Simone N, D'Ippolito S, Ricci C, Gervasoni J, Persichilli S, Del Chierico F, Marzano V, Mortera SL, Primiano A, Poscia A, Ponziani FR, Putignani L, Urbani A, Petito V, Di Vincenzo F, Masi L, Lopetuso LR, Cammarota G, Romualdi D, Lanzone A, Gasbarrini A, Scaldaferri F. (2022). Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study. PMID: 35743789.
- Kyriakides R, Jones P, Somani BK. (2021). Role of D-Mannose in the Prevention of Recurrent Urinary Tract Infections: Evidence from a Systematic Review of the Literature. PMID: 32972899.
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FAQ
What should I do when urinary tract infections keep coming back?
If you have repeated urinary tract infections (UTIs), you should go see your GP. You may be also able to prevent further UTIs from occurring with a few minor lifestyle and diet changes.
