Frequent UTIs During Menopause: Is It Normal?

Menopause is a time of transition often marked by many metabolic changes that can be unpleasant and decrease one’s quality of life. Struggling with UTIs can be frustrating and relentless in the later years. In this article, we'll explore why the risk of UTIs increases during menopause, treatment options, and ways to prevent UTIs.

What is a UTI?

A urinary tract infection or UTI is a bacterial infection of the bladder and related urinary structures. The infection may remain in the bladder and lower ureters, called cystitis or an acute lower urinary tract infection. Bacteria can also travel up the ureters into the kidneys, causing a more complicated infection called pyelonephritis. Approximately 40% of people with vaginas will have at least one UTI in their lifetime, and up to 10% may have yearly infections.

Menopausal and postmenopausal people may suffer from recurrent UTIs (rUTI) — at least three infections within twelve months or two episodes in six months. Recurrent UTIs can be a relapse of a previously active or new infection. UTIs among people with vaginas occur at a high rate because of the closeness of the anus to the urethral opening and a short urethral length. This closeness allows bacteria, most commonly Escherichia coli, to travel from the rectum to the urethra easily.

Causes of UTIs during menopause

The most prevalent cause of an increased risk for UTIs in menopausal and premenopausal people is the changes in estrogen levels and the urogenital microbiome. Before menopause, the urogenital microbiome is filled with beneficial Lactobacillus bacteria that feed off glycogen, or sugar stored by the body, produced by vaginal cells. Glycogen metabolism by lactobacilli produces lactic acid. Lactic acid limits the growth of non-beneficial bacteria.

Lactobacilli bacteria also maintain the health of the vaginal epithelium or outer tissue layer of the vagina’s interior. During menopause, hormonal estrogen levels drop. This change decreases the ability of the vaginal epithelium to produce glycogen to maintain Lactobacilli bacteria and lactic acid at premenopausal levels. The urogenital area is then more vulnerable to infection by other organisms.

Risk factors for menopausal and postmenopausal people

Other than having female genitalia, menopausal and postmenopausal people may have other factors that increase their risk for UTIs, including:

• Sexual activity. Bacteria in the bladder can increase ten-fold after sexual intercourse.
• History. History of UTIs in premenopausal years.
• Type II Diabetes. Those with diabetes have a higher risk of asymptomatic bacteriuria and pyelonephritis.
• Urinary incontinence. This can lead to urine retention within the bladder and create the perfect breeding ground for bacteria.

UTI symptoms

Signs and symptoms of UTIs during menopause and postmenopause are the same as any other life season. UTIs can cause:

• Pain or burning with urination
• Increased frequency of urination
• Urgency to urinate
• Urine leakage
• Pain in and around the pubis
• Hematuria or blood in the urine

When to speak with your doctor?

While it is possible for UTIs to resolve on their own, many people desire symptom relief. Do not hesitate to contact your healthcare provider if you suffer from the above symptoms.

UTIs are diagnosed by symptoms and a clean catch urine sample.

Treatment for UTIs

The standard treatment for a UTI generally involves antibiotics for three days to six weeks. Antibiotic choices include:

• Trimethoprim/sulfamethoxazole
• Fluoroquinolones
• Fosfomycin

The antibiotic choice may be dependent on the bacteria causing the infection. Additionally, treatment with phenazopyridine (AZO), available over the counter, will help with symptom relief. Be aware it may turn urine a red-orange color. Once treatment has started, symptoms usually resolve within two to four days. Those suffering from recurrent UTIs may consider other preventative steps to decrease their risk of reinfection or relapse that results in continued antibiotic usage.

Preventing UTIs during menopause

UTIs can be challenging to prevent in a high-risk population. Studies have shown that basic genital hygiene can help decrease the risk of developing an infection:

• Washing the genital area and urinating after sexual intercourse.
• Wiping front to back after using the bathroom.
• Urinating frequently.
• Drinking appropriate amounts of water.

Due to the high rate of possible reinfection, the impact that repeated antibiotic use can have on the vaginal microbiome, and the development of antibiotic-resistant organisms, it may be helpful to explore other prevention strategies. Some studies have also shown the benefits of:

• Cranberry. While more studies are needed, cranberry supplementation has been shown to reduce recurring UTIs significantly.
• Intravaginal or oral estrogen. Some studies have shown that intravaginal or topical estrogen is more effective than oral estrogen in decreasing UTI risk.
• Ascorbic acid or vitamin C. This vitamin makes urine more acidic and less favorable for bacteria.
• Probiotics. Supplementation with Lactobacilli probiotics has shown positive results, but more extensive scientific studies are required.
• D-mannose. A supplement that is effective in preventing UTIs and used as a treatment for an uncomplicated lower urinary tract infection.

Unfortunately, menopause can contribute to problematic, recurrent UTIs for many. By working with healthcare providers, practicing healthy genital hygiene, and consistency with other preventative measures, many menopausal people can experience relief from UTIs.