Urinary Tract Infections in middle-aged women and during menopause. Its causes, symptoms, and treatment options
Recurrent UTIs are common among both young healthy women and healthy women at midlife. Here’s why. There are many types of bacteria that normally live in the vagina and happily coexist. And they keep each other in check, like a mini-ecosystem. The hormone estrogen allows the “good” bacteria called Lactobacillus to thrive. These bacteria produce acid, which lowers the pH in the vagina, which helps keep the “bad” bacteria in check.
For women at midlife, the main culprits behind recurrent UTIs are physical changes, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, and trouble completely emptying the bladder. The lower levels of estrogen after menopause are also a factor.
Perhaps you’re no stranger to urinary tract infections (UTIs), or maybe you’re the opposite, and you’ve been spared by the urinary health gods. Whichever the case, UTIs after menopause can happen to anyone. They are the second most common type of bacterial infections seen by healthcare providers.
A urinary tract infection (UTI) occurs when bacteria from the bowel enters and travels up the urethra. Women are fairly prone to urinary tract infections because of the shortness of their urethra and the close proximity of the urethra to the vagina and anus. Bacteria that live in this moist environment can spread to the urinary tract during sex or with the use of certain vaginal birth control methods.
Bacteria that travel up the urinary tract can affect the urinary organs beyond the urethra. The urethra and bladder are known as the lower urinary tract. If the bacteria reach the bladder, the woman may develop a bladder infection, also known as cystitis.
If the infection spreads to the upper urinary tract, it affects the ureters and kidneys as well. A kidney infection is known as pyelonephritis and can be a serious medical condition.
Why are women at a higher risk of UTIs post-menopause?
When you are perimenopausal, menopausal, or postmenopausal, the lack of the hormone estrogen plays a key role.
- Vaginal pH: The natural flora of good and bad bacteria exist harmoniously in your vagina. Estrogen allows the “good” bacteria (Lactobacillus) to thrive. Lactobacillus produces acid, which lowers vaginal pH. This ultimately keeps the “bad” bacteria in check. When your ovaries no longer produce estrogen, there are less good bacteria to fight off bad bacteria. Bad bacteria such as E. coli make their way from the rectum to your urethra (the gateway to your urinary tract). This bacteria then attach to the wall of the urethra and results in a urinary tract infection.
- Stress incontinence: Over 40% of menopausal women face urinary incontinence. This happens in advanced age women because, over time, the muscles of the pelvic floor (i.e. the muscles that support your bladder and rectum like a hammock) become weak. Estrogen stimulates blood flow to the pelvic region, which strengthens pelvic floor muscles. Therefore, when estrogen decreases, these muscles become weak, and they lack the strength to keep the bladder closed. In addition, prolonged use of wet, moist absorbent pads exposes your urethra directly to bacteria and increases the chance of a UTI.
- Bladder prolapse: The front wall of the vagina keeps your bladder in place. Lack of estrogen can also weaken the tissues of the vaginal wall, and the bladder can prolapse, or descend into the vagina. This makes it more difficult to empty the bladder completely when urinating. When urine stays stagnant in your bladder, bacteria can multiply and cause a UTI.
- Lower urinary tract symptoms – As they get older many women may find they have problems with their urinary tract (waterworks). Some women may experience OAB leading to problems with urinary urgency. If you would like more information on bladder problems, please visit our main Bladder Problems section
- Recurrent urinary tract infections (UTIs) – Commonly called cystitis, this is another form of a “waterworks” problem. A common symptom of cystitis is a burning pain when passing urine
What are UTI Symptoms for Women after Menopause?
UTIs may present themselves differently in postmenopausal women. The typical features of UTI should next be examined: urinary urgency, frequency, dysuria, hesitancy, and low back pain. Because postmenopausal women may not present to the clinician with “typical” UTI symptoms, it is important to investigate for atypical UTI presentations. Symptoms of increasing mental confusion, incontinence, unexplained falls, loss of appetite, and nocturia are atypical clinical manifestations that may occur in the older postmenopausal female:
- Urosepsis or septic shock (severe hypotension, fever, tachycardia, tachypnea).
- Have symptoms only of urinary incontinence or a combination of symptoms.
- Mental changes or confusion, nausea or vomiting, abdominal pain, or cough, and shortness of breath.
- A study of women aged 18 to 87 years revealed that a generalized sense of “feeling out of sorts” was frequent in adult women with acute uncomplicated lower UTI.
Risk Factors for UTIs
In addition to women who have recently increased their level of sexual activity, certain types of women are more likely to contract a UTI, including women who are post-menopause. Menopause occurs when a woman’s body decreases the production of estrogen, which can weaken the tissues surrounding the urethra and leave it vulnerable to infection.
Diagnosing a Urinary Tract Infection
The test for a UTI is called a urinalysis. Your doctor will ask you to provide a urine sample, which will be examined in a laboratory. Your doctor may also order a culture of your urine sample, which can show the particular types of bacteria that are present.
Treating a Urinary Tract Infection
Most urinary tract infections can be treated quickly and easily with antibiotics, and fortunately, symptoms usually disappear within two days. When taking antibiotics, it’s important to take all of the doses prescribed, even if you are feeling better before you run out of your medication. Failing to take the entire prescription as recommended could result in a relapse of the infection.
In postmenopausal women’s lack of estrogen is the primary cause of urogenital atrophy, the treatments for it in postmenopausal women involve hormone therapy (HT). These can help restore the vagina to premenopausal conditions and relieve many symptoms of urogenital atrophy.
Systemic HT (taken orally and affecting the whole system) may reduce the urinary symptoms of urgency, frequency, nocturia, and painful urination, but there is continuing debate about the effectiveness of systemic HT in treating urogenital atrophy.
Local estrogen, applied externally, is helpful in relieving the symptoms of urinary urgency, frequency, and stress incontinence, and can also help prevent urogenital atrophy and the recurrence of urinary tract infections.
The most common treatment for vaginal atrophy symptoms is low-dose vaginal estrogen level replacement, utilizing creams, tablets or vaginal rings.
However, some women are not able to have HT for any menopausal urinary symptoms such as women with breast cancer. For symptoms of vaginal atrophy, they can use vaginal moisturizers for normal relief and vaginal lubricants to relieve dryness prior to intercourse.
Upper urinary tract infections that affect the kidneys are much more serious and usually require a stay in the hospital. Your antibiotics may be administered intravenously while medical professionals monitor your health.
Frequent Urinary Tract Infections
Having more than two UTIs in a year qualifies as a recurrent infection. Recurrent infections are usually associated with sexual habits, such as:
- Having sex at an early age
- Frequent intercourse
- Sex with a new partner
- Using spermicides or a diaphragm
If you have recurrent UTIs, talk to your doctor about how you can reduce your risk. You may need to switch your method of contraception or practice better hygiene before, during, and after sex. It may feel uncomfortable to talk to your health care provider about your sexual activity, but your gynecologist is a specialist in this area and is here to help you stay healthy.
Reducing Your Risk of Urinary Tract Infections
Doctors recommend several behaviors that you can try at home to decrease your risk of developing a UTI. Some helpful tips include:
- Wipe from front to back after using the bathroom to avoid the spread of bacteria.
- Empty your bladder at least once every three hours, and as soon as you feel the need.
- Empty your bladder before and after having sex.
- Wash your genitals and the skin surrounding your anus with soap and water, and avoid using douches, sprays, or powders.
- Wear cotton underwear.
- Drink plenty of water. Stay well hydrated throughout the day to flush your system.
- Cranberry juice or cranberry pills may aid in preventing UTIs, but the effect is not well understood.
- Estrogen therapy can help prevent UTIs in women who are going through menopause.
Take control of your urinary health, don’t accept UTIs as a fact of getting older. If you are struggling with UTIs, speak with your doctor to find a solution specifically suited for you. Let’s face it, you have better things to do with your time than worry about UTIs.