Maybe it’s been a few months and you were thinking, “oh, yay, finally no more UTIs,” but on your next trip to the bathroom, the burn and ache say otherwise.
Urinary tract infections (UTIs) are incredibly common among women. Some experts say half or more of all women will have at least one in their lifetime. Let's discuss what you need to know about menopause and UTIs.
The most common UTIs are caused by the bacteria E. coli. Normally found in the gastrointestinal tract, E. coli can migrate from the anus to the vagina, hitching a ride on thong underwear or toilet paper used improperly (translation: wiping back to front).
Normally the urinary system can keep these invaders from getting a foothold, but if they get in in enough numbers, they can start to colonize and travel up the urethra, causing pain and burning, the urge to urinate, cloudy or bloody urine, and pelvic pain.
UTIs are annoying and painful, and having to get a prescription antibiotic isn’t ideal, but most UTIs are relatively simple to solve. The problems really begin when a woman gets rid of one infection, only to have it come back a few months later.
Recurrent UTIs – infections that return – are more than just annoying; they can really disrupt your life. If you’re having several UTIs in a year, it might be time to start looking for other causes.
Recurrent UTIs are very common among perimenopausal and post-menopausal women, so we talked to ob/gyn and Gennev Director of Health Dr. Rebecca Dunsmoor-Su about the causes and treatments of the ones that just won’t go away.
According to Dr. Rebecca, there are two main reasons women experience recurring UTIs: either the vaginal tissue and flora have changed, or there’s an anatomical issue that needs to be addressed. Both of these happen frequently in women in perimenopause and menopause. So let’s take them in turn:
A normal, healthy vagina is colonized by lactobacilli. They consume the glycogen our bodies no longer need and produce lactic acid which prevents other, harmful bacteria from invading the vagina.
In perimenopause, estrogen levels start declining. This causes the tissue of the vagina to thin and dry and changes the vaginal pH. Because lactobacilli require a very specific pH to survive and thrive, they may die off during this time in a woman’s life, leaving her much more vulnerable to infections.
If it’s a flora issue, says Dr. Rebecca, she usually counsels patients to consider estrogen or the MonaLisa Touch laser treatment. Both restore homeostasis, returning vaginal tissue to its pre-menopausal pH and allowing lactobacilli to recolonize.
“Estrogen” in this context means the topical ESTRACE cream, Dr. Rebecca says; generally for vaginal complaints, estrogen applied directly to the area in question appears to be more effective than estrogen taken orally. However, the estrogen needs to be at a higher dosage to work, so if you still have your uterus, you’ll need progesterone as well. Vagifem tablets and the Estring ring are low-dose, and while they may work fine for some, they may not provide enough estrogen to combat recurring UTIs in all women.
For those who can’t or prefer not to use hormones, there’s the MonaLisa Touch. The laser can rejuvenate vaginal tissue and increase blood flow to the area, bringing tissues back to their pre-menopausal condition. Once the tissues return to normal, the body’s pH returns, as does the glycogen the lactobacilli need to survive.
Hear our podcast with Dr. Rebecca about how the MonaLisa Touch works and why it’s a good option for many women in menopause.
One of these two treatments is generally necessary to handle the problem. According to Dr. Rebecca, taking a probiotic supplement isn’t particularly effective because the bacteria in the supplement don’t make it to the vaginal canal. Even if they did, the pH still wouldn’t be right for them to survive. Cranberry juice or extract may provide some relief, but more clinical studies need to be done to determine if it really does protect the bladder from bad bacteria.
The other UTIs, she says, are due to anatomical problems. Prolapse and weakened bladder muscles may stop the bladder from emptying completely in urination, and that can lead to recurrent UTIs.
As we age, tissue can weaken; if the tissue between the bladder and the vagina weakens, the bladder may bulge into the vagina, causing a prolapse or “cystocele.” If the bladder drops enough, it’s no longer in an ideal position for voiding completely. Bulges may form pockets where urine pools and doesn’t make it out.
If bladder muscles are weak, they don’t contract properly anymore, and again, a woman may not be able to empty her bladder completely.
The urine that isn’t expelled becomes a breeding ground for unhealthy bacteria, enough of the bad bacteria build up to overwhelm the good bacteria, and pretty soon, the woman finds herself with another UTI.
First, get a diagnosis from an ob/gyn, Dr. Rebecca says, so you know what’s actually happening. Then, if appropriate, a physical therapist may be able to help strengthen weak bladder and pelvic floor muscles. Medication can help you empty your bladder more completely, and if the problem is a prolapse, surgery might be your best bet.
Depending on the reason you have recurrent UTIs, there are a few things you can do to reduce your risk: schedule an appointment with a pelvic physical therapist for help with pelvic floor strengthening; stay hydrated so you’re using the bathroom every 2 – 4 hours; empty your bladder as completely as you can; pee immediately after intercourse; if your doc approves it, try Uqora for UTIs, take one dose of antibiotic before engaging in behavior that often triggers a UTI (like intercourse); and since it doesn’t hurt and might help, drink cranberry juice, if you like it, but watch the sugar.
Most women get a UTI at some point, and often once they’re over, they’re over. But if you’re suddenly having 3 or 4 UTIs in a year, that’s less common, and it might be time to check with your ob/gyn.
Dr. Rebecca advises you to have a culture done so you know what bacteria you’re dealing with. If it keeps coming back, you might have a resistant strain of bacteria that needs a different treatment, or perhaps you’ve just been taking the wrong medication. UTIs don’t go away on their own, so don’t wait to get help from a medical professional.