Menopause and UTIs: what’s the connection?

While everyone seems to talk about hot flashes and night sweats during menopause, one surprising issue many women face is a spike in urinary tract infections (UTIs). The culprit for this is falling estrogen levels. Estrogen helps protect your urinary and vaginal tissues. When those levels drop, your urinary tract becomes more vulnerable to the bacteria that cause UTIs.

Does perimenopause or menopause cause UTIs?

Your risk of getting urinary tract infections goes up during perimenopause because your estrogen levels start dropping. Estrogen helps keep your urinary tract healthy and protected. Without enough of it, bacteria have an easier time getting in and causing trouble.

A UTI happens when bacteria (usually E. coli from your digestive system) get into your urinary tract and multiply. During perimenopause and menopause, several changes in your body make this more likely to happen. 

Here’s why UTIs become more common during menopause:

• Tissues get thinner and drier:  Estrogen helps protect your vaginal and urethral tissues by keeping them thick, moist, and elastic. When estrogen falls, these tissues thin and dry out, making it easier for bacteria to settle in and cause infection.
• Your vaginal microbiome changes: Before menopause, estrogen supports the good bacteria that help protect you. As estrogen declines, so do those helpful bacteria. Your pH levels rise too, creating conditions where harmful bacteria can thrive.
• Local immune defenses weaken: Lower estrogen means less blood flow to the area and fewer infection-fighting cells where you need them. This weakens your mucosal immunity, which is the first line of defense in your lower urinary tract. 
• Pelvic floor muscles lose strength: During perimenopause, your pelvic floor weakens, and the support around your urethra shifts. This can make it harder to fully empty your bladder, leaving behind urine where bacteria can grow.

Urinary tract infection (UTI) symptoms

During menopause, UTIs don’t always show up the way you’d expect. It gets tricky because menopausal changes themselves can cause urgency, frequency, and burning from dryness that feels like a UTI, even when no infection is present. This can lead to actual UTIs being missed or misdiagnosed. It can also mean getting treated for an infection you don’t actually have.

Common UTI symptoms at any age include:

• Pain or burning when you pee 
• An urgent or frequent need to go 
• Cloudy or foul-smelling urine 
• Pelvic discomfort 
• Blood in your urine
  

UTI symptoms, more common during perimenopause and menopause, include:

• General pelvic aches
• Feeling a little “off” or “out of it”
• Confusion and increased brain fog
• Delirium (in more severe cases, especially with older women)
• Bladder control issues
• Unusual tiredness that leaves you feeling wiped out
• Nausea or vomiting 

How can you prevent UTIs during menopause?

You can’t prevent every UTI, but there are solid ways to lower your risk and support your urinary tract health during menopause:

• Drink plenty of water throughout the day
• Pee when you need to (don’t hold it)
• Pee before and after sex
• Skip scented soaps, sprays, and harsh cleansers around your vulva and vagina
• Skip douching
• Wipe front to back after you pee
• Wear breathable cotton underwear
• Use vaginal moisturizer or lubricant to address dryness

Can vaginal estrogen treat recurring UTIs in menopause? 

There’s compelling evidence that regular use of vaginal estrogen can cut recurrent UTI rates by more than half in menopausal women. 

Dr. Sheryl Ross (Dr. Sherry), Chief Medical Officer of Women’s Health here at QuickMD, observes that, “Most women associate UTIs with sexual intercourse. But for women who have GSM [genitourinary syndrome of menopause, a condition caused by declining estrogen], they are more prone to UTIs.”

Vaginal estrogen works to restore the tissues in your vagina and urethra that have thinned and dried out from menopause. It also brings back the good bacteria that help protect you, lowers your pH to less bacteria-friendly levels, and improves blood flow and local immune defenses.

It’s been found that women who use vaginal estrogen regularly decrease their incidence of recurrent urinary tract infection by over 50%

One large study tracked over 5,600 women who were getting around four UTIs per year. After using vaginal estrogen regularly for one year, their UTI rate dropped by 52%. That’s a significant drop, especially when you’re already dealing with everything else menopause throws at you.

Vaginal estrogen comes as a cream, tablet, or ring that you insert into your vagina. It works locally where you need it, with very little absorption into your bloodstream. Dr. Sherry notes that, “For women dealing with recurrent UTIs during menopause, it’s often the first treatment doctors recommend.”

Other ways to treat UTIs during menopause

If you’re dealing with a UTI, you want relief fast while the antibiotics clear the infection. Here’s what treats it and what helps with symptoms in the meantime.

Prescription treatments:

• Antibiotics: These are the standard treatment for confirmed UTIs. Your provider will choose which antibiotic based on the severity of your symptoms, the type of bacteria involved, and whether you get UTIs frequently.
• Urinary pain relievers: Medicines like phenazopyridine don’t treat the infection itself, but can reduce any burning or discomfort you feel while antibiotics do their work.
• Vaginal estrogen: If you’re dealing with recurring UTIs, low-dose vaginal estrogen helps restore tissue health and reduce future infections. This isn’t given to treat UTIs, but rather prevent them from happening again.
  

Non-prescription and supportive treatments:

• Stay hydrated: Getting plenty of fluids will help flush bacteria out of your urinary tract.
• Use a heating pad: Gentle heat can ease bladder pressure or pelvic discomfort.
• Avoid bladder irritants: Caffeine, alcohol, acidic drinks, and spicy foods may make your symptoms worse if you have an active infection. 
• Get rest: UTIs can stress your body, but rest supports your immune function and helps with recovery.

Interested in menopause hormone therapy? Discuss your options with our doctors

Menopause and perimenopause come with a variety of stumbling blocks. But you don’t simply have to tough it out. Recurring UTIs during menopause are treatable and can be controlled. 

We offer same-day virtual visits with trusted doctors who understand menopause and all its ups and downs. Discuss your options with us to help you feel more like you.