Highlights from this article:
- Chronic UTIs are more common in perimenopause and menopause.
- Changes in estrogen can impact your vaginal pH.
- As levels of estrogen decrease, the lining of your vagina, urethra, and bladder become thinner and more susceptible to harmful bacteria like E. coli.
- Weakening of the pelvic floor is common with age and can increase the risk of UTIs.
If there’s one thing all people with vaginas can relate to, regardless of age, it’s that urinary tract infections (UTIs) are the worst thing ever. And if you’re currently going through menopause, you might know firsthand that, unfortunately, UTIs are a lot more common in menopause.
Urinary tract infections can affect your bladder (this is called cystitis), urethra (urethritis), or kidneys (pyelonephritis). They’re primarily caused by a bacteria called E. coli — which normally lives peacefully in your colon — entering your urinary tract.
Sex is often to blame for UTIs in younger women but in perimenopause and menopause, the culprits can also be hormonal and physical changes such as lower levels of the hormone estrogen, thinning of the vaginal tissue, and incontinence.
Let’s dive into the reasons why menopause can increase your risk of UTIs and what you can do to prevent it.
Why menopause makes you more prone to UTIs
There are two main reasons why menopause increases your risk of UTIs: changes to your vaginal microbiome and issues with the pelvic floor. Both are the result of decreasing levels of estrogen.
How menopause affects the vaginal microbiome
Estrogen plays a very important role in the vaginal microbiome. Estrogen causes changes in the vagina that allows protective bacteria like lactobacilli to thrive. Specifically it helps your body produce glycogen - a food source - for beneficial bacteria called lactobacilli. These bacteria keep vaginal pH acidic, and prevent the overgrowth of potential pathogens like E. coli.
In perimenopause (the phase leading up to menopause), estrogen levels start declining. This also means that food for lactobacilli decreases, so their numbers start to decline. This change in your vaginal microbiome results in a change in your vaginal pH, leaving your urinary system more vulnerable to harmful bacteria and increasing the risk of UTIs.
If you're curious about what's happening in your vaginal microbiome, you can try testing it with Evvy's Vaginal Microbiome test. It's a quick, 30-second, at-home swab that will tell you all the protective and disruptive bacteria and fungi in your vaginal microbiome. This includes measuring the percentage of protective lactobacilli in your vaginal microbiome, which can help you understand if the decrease in estrogen could be affecting your vaginal health.
Estrogen can also affect the health of your pelvic organs. Lower levels of estrogen in perimenopause and menopause can thin the lining of your vagina and urinary tract, making it more susceptible to harmful bacteria.
How menopause affects the pelvic floor
Your pelvic floor acts like a sling that supports your uterus, bladder, urethra, and bowels to help them function efficiently. But a weak pelvic floor can cause bladder prolapse, where the bladder drops and bulges into the vaginal wall. This also makes it harder to empty your bladder fully, increasing your risk for UTIs.
The urine that isn’t expelled hangs around in your bladder and becomes a breeding ground for harmful bacteria, giving them a chance to colonize (instead of being flushed out).
What are the signs of a UTI?
Common symptoms of a UTI include:
- Discomfort, stinging or burning when you pee
- A frequent, sudden need to pee
- A constant feeling that you need to pass urine, even when your bladder is empty
- Pain in your lower abdomen
- Cloudy, strong-smelling urine that may have blood in it
How to prevent UTIs in menopause
Aside from the classic preventative methods — drinking plenty of water, wiping front to back, peeing after sex — you can further help to reduce the chance of getting a UTI in menopause with a few more solutions:
- Talk to your doctor about vaginal estrogen. Adding estrogen back into the vagina helps restore and strengthen the lining of the vagina and may help manage symptoms like vaginal dryness and UTIs. It can also help restore the protective vaginal microbiome by restoring the food source for Lactobacillus. This will help keep the pH low and healthy (something that moisturizers and lube don’t do).
- Keep your genital area clean and dry. If you use incontinence pads, remember to change them regularly to prevent bacteria from entering your urinary tract.
- Limit your intake of bladder irritants like caffeine and alcohol.
- Take a D-mannose supplement. Some evidence suggests D-mannose may help prevent chronic UTIs.
- Strengthen your pelvic floor to reduce your risk of prolapse. You can do pelvic floor exercises at home or with the help of a pelvic floor physiotherapist.