Alissa Yarkony is a Pelvic Health Physical Therapist, certified Women’s Health Coach, and Menopause Coach at Elektra Health. She has spent the last 25 years focusing on women’s health and recently completed additional certifications in Women’s Health Coaching and Perimenopause/Menopause.
During perimenopause and menopause, the drop in estrogen can make you more prone to urinary tract infections (UTIs) and weaken your pelvic floor muscles, leading to incontinence. Both issues can have overlapping symptoms, which can be confusing and affect your daily life. Let’s dive in with Alissa Yarkony to better understand UTIs, how to prevent them, and options for treatment, especially during the menopause transition.
UTIs 101
Versalie: Why do UTIs happen in the first place? Does being in perimenopause or postmenopause change this?
Alissa: It’s pretty common to experience more frequent or recurrent UTIs as you go through the later stages of the menopause transition. The vaginal tissues become thinner and drier, and the vaginal microbiome shifts, making it easier for infections to take hold. Pelvic organ prolapse and not fully emptying your bladder can also contribute to UTIs.
V: What are the typical signs of a UTI when you’re going through perimenopause or postmenopause?
A: UTI symptoms during perimenopause and menopause are similar to UTI symptoms in younger adults. You might notice:
- Frequent urge to urinate, even when little comes out.
- Burning sensation during urination.
- Cloudy, dark, or strong-smelling urine.
- Pain or pressure in your lower abdomen or back.
- Possible low-grade fever.
But these UTI symptoms can easily be mistaken for common menopause symptoms like:
- Increased urinary urgency, frequency, or incontinence (often related to genitourinary symptoms of menopause, or GSM).
- Discomfort or pain during sex (due to vaginal dryness and low estrogen).
- Generalized pelvic achiness or cramps.
- Feeling under the weather and general joint pain.
V: Are UTIs more common for females 45+ compared to younger folks?
A: UTIs can be more common for those going through perimenopause and postmenopause because:
- The vaginal lining thins.
- The pH of the vagina changes, reducing good bacteria and increasing bad bacteria.
- Urinary retention can lead to bacterial build up.
- Sex with vaginal dryness can trigger a UTI.
V: Are UTIs more frequent during perimenopause or postmenopause?
A: UTIs are more frequent during postmenopause.
V: Why are UTIs and BV (bacterial vaginosis) more common as we get older and hit the later stages of menopause?
A: Estrogen helps keep the vaginal tissues thick, elastic, and lubricated. It also promotes the production of glycogen, which feeds good bacteria like Lactobacillus. When estrogen levels decrease, there’s less glycogen to support these good bacteria, leaving room for BV-causing bacteria to overgrow. This is why UTIs and BV become more common during menopause.
How to help prevent a UTI
V: Why is drinking plenty of water so crucial for preventing UTIs?
A: Drinking more water dilutes your urine and makes it less irritating to your bladder. It also helps flush out bacteria, reducing the risk of infection.
V: What are some simple habits we can adopt to help prevent UTIs?
A:
- Moisturize your vulva. Vaginal moisturizers help draw moisture into the vaginal and vulvar tissues, which typically have less elasticity during menopause.
- Pee after sex to flush out any bacteria.
- Quit or limit smoking, since it’s associated with a higher risk of UTIs.
V: Can probiotics help prevent UTIs during menopause?
A: Studies on probiotic supplements for UTI prevention and treatment have shown mixed results. But they can’t hurt and may help. I suggest trying probiotics with lactobacillus rhamnosus and lactobacillus reuteri, often labeled as “vaginal and urinary health” probiotics.
Talk to your doctor if you have any questions or concerns about any products, including probiotic supplements.
V: Are there any supplements that can help prevent UTIs?
A: Cranberry extract contains proanthocyanidins (PACs), a compound found naturally in cranberries that supports urinary health. There’s some evidence that PACs help prevent bacteria from sticking to the bladder wall. This may be a useful addition to your UTI prevention strategy.
What to do if you have a UTI
V: What should the first step be if you think you have a UTI?
A: If you think you have a UTI, drink more water and see your healthcare provider. They can confirm the diagnosis and prescribe the right treatment.
V: What are my options if I need to treat a UTI?
A: The only true treatment is a course of culture-sensitive antibiotics that have been shown to be effective against the specific bacteria causing the infection that’s identified through a urine culture. Getting a urine culture is important, especially if you’ve had UTIs before, to ensure the right antibiotic is used. You usually need to take antibiotics for 3-7 days, but it can vary.
V: How can vaginal estrogen therapy help with UTIs during menopause?
A: Urinary symptoms are often grouped together with issues like vaginal dryness, irritation or itching of the vulva, pain with sex, and reduced arousal, all of which constitute genitourinary symptoms of menopause (or GSM, for short). Local vaginal estrogen application is an effective treatment for GSM, and is shown to be beneficial for vaginal dryness, pain with intercourse, and bladder health.
V: Can vaginal laser therapy make a difference for UTI symptoms?
A: Vaginal laser and radiofrequency treatments are not a treatment for UTIs, but may be a helpful addition to other treatments for UTI symptoms due to menopausal changes. They work by burning a grid of tiny holes in the tissue surface, stimulating tissue repair and healing. Radiofrequency treatments heat up vaginal tissues to stimulate collagen and elastin production. However, more evidence is needed as effectiveness is still a topic of debate among gynecologists and urogynecologists.
UTIs and other symptoms
V: Is urinary incontinence linked to UTIs?
A: UTIs can cause inflammation and irritation in the bladder, leading to muscle spasms and incontinence. Chronic UTIs can also cause damage to the bladder lining, resulting in long-term bladder issues.
V: What are the menopause symptoms that are connected to UTIs?
A: Menopause symptoms that often come with frequent UTIs are urgency, frequency, and incontinence.
How to manage frequent or recurrent UTIs
V: What should I do if I’m dealing with frequent UTIs?
A: If you’re having more than 3-4 UTIs a year or have a more severe case of incontinence, it’s a good idea to see a urologist or urogynecologist. They can develop a tailored treatment plan for your symptoms.
V: What lifestyle tweaks can we make to cut down on recurring UTIs?
A:
- Moisturize your vulva to keep the tissues hydrated.
- Pee after sex to flush out bacteria.
- Quit or limit smoking to help reduce the risk of UTIs.
Elektra Health is a female-founded digital health company providing evidence-based menopause care, education, and community.
