Menopause is a natural biological process that marks the end of a woman’s reproductive life. While menopause comes with several physical and psychological changes, one issue that often goes undiscussed is the increased risk of urinary tract infections (UTIs). UTIs are bacterial infections that affect the urinary system, and women in their menopausal years are more prone to these infections than any other time in their lives. UTIs can be a tremendous discomfort to anyone who experiences them.  And approximately 50% of UTIs in postmenopausal women develop into recurrent UTIs, which is clinically defined as 2 symptomatic UTIs in 6 months or three symptomatic UTI episodes in 12 months.  

While up to 15% of women over 60 will develop frequent UTIs, this percentage increases to 20% for women aged >65 years. Approximately 25-50% of women aged >80 years have detectable bacteriuria on a standard urine culture.  So you can see this is a growing problem for post-menopausal women. 

Why are UTIs more common in menopause?

Declining estrogen levels play a critical role in the health of the vagina and urinary tract. As women age and enter menopause, their body’s ability to produce estrogen declines, and their urethra thins out and becomes less elastic. The thinning of the urethra allows bacteria to move more easily, increasing the risk of UTIs.

 We also see a change of the Vaginal pH.  The vaginal microbiome becomes less acidic, which creates a favorable environment for bacteria to thrive. The changes in the urinary microbiome also make it easier for bacteria to grow and adhere to the urinary tract. Estrogen deficiency during menopause leads to a rise in vaginal pH making it a more alkaline environment which can substantially change the vaginal bacteria. Lower vaginal and systemic estrogen, as characterized by menopause, decrease the lactobacillus dominant vaginal flora typical of premenopausal women. This increases the chance that microbes (e.Escherichia coli and Enterococcus) establish residence in the vagina which can predispose one to UTIs. This change in the vaginal environment increases the risk of urinary tract infections.

What are some of the common symptoms of UTIs in menopause?

While the symptoms of UTIs are generally the same for women of all ages, menopausal women are more prone to developing recurrent UTIs.

The symptoms of UTIs include:

• Pain or burning sensation during urination
• Frequent urge to urinate
• Cloudy urine
• Blood in urine
• Pain or discomfort in the lower abdomen

If you are experiencing any of these symptoms, it is important to visit your healthcare provider for proper diagnosis and treatment.

Treatment options for UTIs

Treating UTIs promptly is very important, as we do not want the infection to progress and lead to a more serious infection.  There are various treatment options available for UTIs.  Typically, they are treated with antibiotics prescribed by your medical doctor. Antibiotics are prescribed based on the severity and frequency of the infection as determined by a physical exam, urinalysis and urine culture. However long-term or recurrent use of antibiotics can disrupt the vaginal microbiome and potentially increase the likelihood of developing recurrent infections. Acute treatment and management is important but so is having a strategy and treatment plan geared at prevention.  We know post-menopausal women are at an increased risk of recurrent UTIs and this can have significant effects on a women’s quality of life, so prevention is key!

Some preventative measures include:

• Drink plenty of water to stay hydrated
• Urinate frequently, especially after sexual intercourse
• Wipe from front to back after using the toilet
• Wear cotton underwear and avoid tight-fitting clothing
• Avoid using irritating products such as douches, powders, and sprays
• Avoid bladder irritants like caffeine, alcohol, and sugar
• Talk to your health care provider to see if a probiotic is right for you – they can help to rebalance the healthy bacteria in the vagina and urinary tract, reducing the risk of UTIs

The hormonal changes during this time create a favorable environment for bacteria to grow, leading to an increased risk of UTIs.  While the above strategies can be very supportive, often the addition of a local estrogen can be quite helpful.  Local estrogen is a viable treatment option to help restore the vaginal pH, moisture and potentially support the rebalancing of the vaginal microbiome.  If you are struggling with recurrent UTIs connect with your practitioner to discuss if topical estrogen therapy is right for you.

Dr. Natalie McCulloch ND is a naturopathic doctor and owner of Durham Natural Health Centre – a wellness clinic in Ajax, ON.  Natalie has been in clinical practice for over 12 years and quickly recognized the gap in care that women receive in peri/menopause and has dedicated her practice to helping women navigate mid-life with confidence, grace, support and an understanding of what is happening to their body. She sees women virtually all over the province of Ontario. 

If you’d like to learn more about menopause care or our unique treatment options, visit our website or follow us on Instagram.

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