How can I Prevent UTIs during Menopause

Urinary tract infections, or UTIs, affect people of every age and sex, although women are more susceptible than men due to a shorter urethra. According to The Kidney Foundation, Canadian women make about half a million doctor visits due to a UTI.

For women in their menopausal years, a UTI can fall under the umbrella term “genitourinary syndrome of menopause” (GSM), a condition that affects the vagina, vulva, and lower urinary tract due to a decrease in estrogen. 

Urinary tract infections are common during and after perimenopause. They can be very uncomfortable and typically require medical treatment — but there are lifestyle and dietary adjustments you can make to help prevent recurrent UTIs during menopause. Read on to learn what a UTI is, what the most common risk factors are, and steps you can take to reduce your chances of getting one.

What are UTIs and how do they affect women during menopause?

Urinary tract infections are caused by fungi, viruses, and bacteria. They can affect the kidneys, bladder, ureters, or urethra — or the entire urogenital system. Symptoms of a can UTI include: 

• Pain or burning while urinating
• Frequent, urgent, and/or incomplete urination
• Urine in the blood 
• Cloudy, strong-smelling urine
• Pressure or cramping in the lower abdomen

If the infection impacts the kidneys, you may also experience fever, chills, nausea or vomiting, and lower back or side pain.

UTIs are the most common bacterial infection in women. They increase in frequency after menopause due to a number of factors, including symptoms related to GSM, such as vaginal dryness and vulvar atrophy, which can create an opportune environment for microbes to enter the urethra and cause a UTI.

Risk factors for UTIs in menopausal women

While 36% of women experience recurrent UTIs before menopause, 53% have chronic UTIs after menopause. Here are the most common risk factors for UTIs in menopausal women.

A history of UTIs

A history of UTIs increases the likelihood you’ll experience them during and after menopause, whether they’re due to abnormal pelvic anatomy, such as a shortened urethra, or other common risk factors.

Decreased estrogen production

The decrease in estrogen that begins during perimenopause can change the lining of the bladder and pH level, causing an imbalance of the good bacteria that provide a natural defense against UTIs. Decreased estrogen levels may also cause anatomical changes in the genitourinary tract, increasing the risk of a UTI.

Urinary retention 

If you’re unable to empty your bladder completely when you urinate or don’t drink enough fluids to make higher urine volumes, you may have a higher risk of developing UTIs. Bacteria can build up in the urine left behind, leading to a UTI, bladder stones, or even kidney damage.

Frequency of sexual intercourse

Sexual intercourse and other types of sexual activity introduce bacteria from the vagina, colon, anus, or fingers into the urethra, which can cause a UTI. Frequent intercourse, more than two times a week triples the risk for UTIs in women of any age — and the risk increases with spermicide-coated condom or diaphragm use. 

Spermicide use

Spermicides decrease your body’s natural probiotic microbes and increase the pH of the urogenital system, creating a favourable environment for an infection to take hold.

Diabetes

People with diabetes are prone to immune system impairment and poor metabolic control, which can contribute to UTIs — especially if the disease isn’t managed properly. Diabetes-related nerve damage can lead to incomplete emptying of the bladder, increasing the risk of UTIs. 

How to prevent UTIs in menopause

You can’t control the physiological changes that accompany menopause, but you can reduce your risk of UTIs with these helpful tips.

Urinate often

Every time you urinate, bacteria and other waste is removed from your bladder and urinary tract, reducing your risk of infection. Try to flush out your bladder by slowly increasing your fluid intake. 

Practice good hygiene

Hygiene plays an important role in the prevention of UTIs. Follow these best practices to keep infections at bay: 

• Wipe from front to back. 
• Wear breathable undergarments. 
• Choose showers over baths.
• If you take baths, avoid adding bubbles or oils.
• Don’t use feminine hygiene sprays, douches, and other hygiene products containing fragrances. 
• Urinate immediately after sex.

Make positive lifestyle changes

A healthy lifestyle that includes regular exercise, plenty of rest, and a nutritious diet can boost your immune system, improving your chances of fighting off a UTI — and it can help reduce a variety of menopause symptoms, too. A diet rich in vegetables and low in sugar can help balance the pH in the genitourinary environment to lower your risk of getting a UTI.

Stay hydrated

We often mention the importance of staying hydrated, and UTI prevention is another reason to drink plenty of fluids, which help flush the system and prevent UTI-causing microbes from taking hold. 

Is there such a thing as too much water? Yes — especially for anyone with heart or kidney disease, but most people don’t drink enough. Everybody is different and requires a different amount of fluid to stay hydrated.

You are more likely hydrated if you: 

• Are urinating every few hours throughout the day 
• Feel well and not fatigued or irritable 
• Are not feeling thirsty (although this is not the best predictor, especially in older people)

Since your body can only process so much water at a time, hydrate regularly throughout the day rather than all at once for the best results.

Drink cranberry juice

Although cranberry juice isn’t effective for treating a UTI, it contains compounds that may help prevent UTIs or reduce the intensity of symptoms until you can visit with your healthcare provider. One compound, D-mannose, is a type of sugar used to prevent certain bacteria from sticking to the walls of the urinary tract. Choose a cranberry juice variety that’s 100% juice, with no added sugar.

Take a probiotic

Probiotics, including yogurt, kefir, and supplements, help improve the health of the good bacteria in your gut and urinary tract. Choose a plain yogurt or kefir without added sugar. If you prefer a probiotic supplement, look for one with at least one billion colony-forming units (CFUs) of Lactobacillus, Bacillus, Bifidobacterium, or Saccharomyces boulardii. 

Probiotics are especially important if you’re taking an antibiotic to treat a UTI or other infection. Antibiotics disrupt the natural flora in your body and can increase your risk for yeast infections. Help build your healthy flora of good bacteria after finishing your prescribed antibiotics.

Medical interventions for UTI prevention

UTIs are considered recurrent, or chronic, if you experience two or more during a six-month period or have more than three per year. For some women who have chronic UTIs, low-dose antibiotics or vaginal estrogen therapy may be effective for preventing them. Before prescribing preventive medications, your doctor will perform various tests to ensure your urinary tract is healthy and rule out other issues, then work with you to determine which preventive intervention is right for you. 

Low-dose antibiotics

In some cases, low doses of antibiotics can be taken for around six months to help prevent UTIs from occurring. The downside of this prevention method is a higher risk of creating antibiotic-resistant bacteria, making future UTIs potentially more difficult to treat.

Vaginal estrogen 

The decrease in estrogen production that starts in perimenopause is an important factor for an increased risk of UTIs. Vaginal estrogen is a low-dose prescription hormone replacement therapy that can help reduce occurrences of UTIs as well as relieve vaginal dryness, itching, and soreness. Vaginal estrogen comes in the form of a cream, ring, or suppository that’s inserted into the vagina. The estrogen is absorbed through the bloodstream.

When to talk to your doctor

The symptoms of a UTI can be very uncomfortable, but even if the symptoms are mild, they can quickly become worse. UTI treatment with antibiotics is highly effective for resolving the infection. Left untreated, a UTI can become worse, moving into your kidneys and causing a kidney infection — or spreading throughout your body, causing sepsis. Talk to your doctor right away if you have symptoms of a UTI — especially if you have a fever or blood in your urine.

If you’re one of 6.5 million Canadians without a primary care provider, you can see a doctor or a nurse practitioner 24/7 on Maple. If prescriptions are needed, Maple can send them to your door or your closest pharmacy.

Information presented here is for educational purposes, and not to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.