Many people in menopause notice that they experience more urinary tract infections (UTI) than they did in their younger years. For some, if they’re left untreated, they may end up in the hospital facing more serious conditions, such as sepsis and delirium. Why are UTIs more common and more serious after menopause?
“When we look at recurrent urinary tract infections in a post-menopause population, it is devastating,” Dr. Lauren Streicher, a professor at Northwestern University and host of “Dr. Streicher’s Inside Information: The Menopause Podcast,” tells TODAY.com.
“It’s one of the easiest, solvable conditions out there, and yet, not only do woman not know they’re associated with menopause, but neither do their doctors. These women keep getting unnecessary and often the wrong antibiotics. They get unnecessary procedures," she explains. "They’re miserable, and they get in trouble where they end up with sepsis and people die — and I’m not overstating this.”
What is it about menopause and UTIs?
A UTI occurs when bacteria enters the urethra and travels up to the bladder and causes an infection, Dr. Adi Katz, director of gynecology at Lenox Hill Hospital, tells TODAY.com. Women are more prone than men to developing them at any point in their lives because their urethra are shorter and closer to the anus.
But the changes that people undergo during menopause make them even more likely to occur.
“The balance that was kept in the vagina (from) the hormones is no longer there,” Katz says. “They no longer have the protection of the lactobacillus and the estrogen in that environment.”
This change allows the bad bacteria to flourish.
“What happens is that the E. coli (from the anus) has absolutely no trouble at all making their way up the urethra and hanging out in the bladder,” Streicher explains. “And this can occur again and again and again.”
According to the Centers for Disease Control and Prevention, urinary tract infections symptoms include:
- Burning or pain with urination
- Feeling the need to urinate even though the bladder is empty
- Urinating more often
- Blood in the urine
- Abdominal pain and cramping
Post-menopausal people might notice they experience recurrent or persistent urinary tract infections, defined as more than two infections in six months, and more than three infections in a year, Streicher says.
She notes, though, that other menopause symptoms can make it difficult for women to know if they have a UTI.
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“The other thing that makes it a little trickier in the post-menopause population is a lot of people think they have a UTI and they don’t,” she says. “When you look at the symptoms of a urinary tract infection — that gotta-go feeling, the urgency, the burning — you can get that just as a consequence of genitourinary syndrome of menopause, and it’s not an infection.”
Genitourinary syndrome of menopause (GSM) is a condition that occurs because postmenopausal women have less estrogen, and that contributes to vulvar atrophy. According to Johns Hopkins, GSM causes a variety of symptoms including:
- Vaginal dryness
- Pain during sex
- Difficulty sitting at times
- A frequent urge to urinate
“The treatment is different. If you have a urinary tract infection, you need antibiotics to treat it,” Streicher says.
Treatments for recurrent UTIs
While UTIs feel painful and uncomfortable and can lead to severe illness, there are several prescription treatments that can reduce recurrent UTIs.
Vaginal estrogen, which can be a cream, insert, a pill or ring, can contribute to the “restoration of the vaginal microbiome to reduce UTI risk,” according to a 2020 paper in “Reviews in Urology.”
“The No. 1 benefit (of vaginal estrogen) is (it's) going to correct your vaginal pH (and) the alteration in the microbiome,” Streicher says. “It is basically going to eliminate recurrent UTIs.”
Vaginal estrogen doesn’t impact the circulating estrogen in the body like hormone replacement therapy (HRT), she says, so it doesn’t have the same risks associated with HRT.
For those who don’t feel comfortable taking estrogen, there are other treatments, such as a DHEA insert in the vagina. DHEA stands for dehydroepiandrosterone, a hormone.
“DHEA is very interesting because DHEA is the building block for both estrogen and testosterone, and in the vagina, you not only have estrogen receptors, but also testosterone receptors as well,” Streicher says. “By putting a DHEA suppository in your vagina, your own vagina cells kick in and make local estrogen and testosterone.”
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This can help treat both GSM and UTIs. “This is a daily suppository that women put in their vagina that works really well,” Streicher says.
Another possible treatment is ospemifene, a selective estrogen receptor modulator (SERM), which can be used to either “activate estrogen receptors or block them in different parts of the body,” Streicher says. Ospemifene turns on estrogen receptors in the vagina and turns them off in the breast. It’s used to treat vaginal dryness, but it also helps with recurrent UTIs, making it a good treatment for those who might experience both.
“It’s very cool,” Streicher says, adding that it’s a daily pill, and even though it’s not FDA approved for recurrent UTIs, the data shows it can decrease them.
Too often women think that bladder infections are simply part of being a woman and don’t seek help. But Streicher hopes this changes.
“Anybody who’s had a bladder infection, a real one, they know it’s miserable and symptoms are horrible, but they don’t look at it as something that could be potentially life-threatening,” she says. “And the message certainly is not out there particularly in older women.”