Why You’re More Likely to Get a UTI During Menopause

That relentless urge to pee and burning sensation when you do are all-too-familiar symptoms of a urinary tract infection (UTI)—one of the most common infections that up to 60 percent of women will experience in their lifetime (1). And in what might feel like a cruel twist of fate, menopause ups your odds of dealing with the bacterial infection, alongside those other unpleasant yet common symptoms like hot flashes and irregular periods.

The somewhat comforting news: once you reach menopause, UTIs are rarely caused by anything you’ve done wrong (like, say, not peeing right after sex). Instead, the culprit is likely a decline in estrogen levels that starts during perimenopause, OB-GYNs say (2). The other good news: There are expert-backed steps you can take to prevent UTIs during menopause, like using vaginal estrogen.

About the Experts

Mary Jane Minkin, MD is a clinical professor of obstetrics and gynecology at Yale University School of Medicine, board-certified OB-GYN at Yale-New Haven Hospital, and North American Menopause Society Certified Menopause Clinician.

Wendy Goodall McDonald MD is a board-certified ob-gyn at Women’s Health Consulting in Chicago and a contributing faculty member at Northwestern Prentice Women’s Hospital.

Why Are Menopausal Women More Prone to UTIs?

First, a quick recap. Most UTIs are caused by bacteria that enter the urinary tract through the urethra and then spread into the bladder. Women are more prone to UTIs than men because their urethra is shorter, making it easier for bacteria to reach the bladder. 

Women become even more prone to UTIs as they age—the prevalence of UTIs in women over 65 is approximately double the rate seen in the female population overall (1). Recurrent UTIs (defined as two UTIs in six months or three in a year) are also common after menopause. One review found that 53 percent of women over the age of 55 report having a UTI come back within the same year (3).

This is primarily due to, you guessed it, hormonal changes. 

A decline in estrogen levels raises pH and weakens defenses

You may already know that a drop in estrogen levels beginning in perimenopause triggers vaginal dryness. But it isn’t only the vagina affected by this hormonal change.

“We all need to remember that the vagina, bladder, and urethra are all lined by the same type of tissue that is coated with lots of estrogen receptors,” says Professor Mary Jane Minkin, M.D. “So when the vagina is dry, the bladder wall and the urethra are also dry and susceptible to being invaded by bacteria,” she explains. 

When the vagina is dry and lacking estrogen, the “good” bacteria in the vagina called lactobacilli aren’t being fed, Minkin says. “As a result, lactobacilli die off, and don’t make the lactic acid that keeps the vagina acidic and fights ‘bad’ bacteria,” she adds. 

Plus, estrogen loss can also make you more prone to UTIs by weakening the muscles of your urethra, making it easier for bacteria to move up into your bladder. “In the presence of estrogen, the urethra walls are thicker and stronger, creating a stronger barrier like a sturdy door against bacteria. Without estrogen, the tissue gets weaker, and the urethra can even shorten. That makes the door rickety and prone to break,” explains Wendy Goodall McDonald, M.D. 

As a result of these changes, Minkin says, “You end up with nastier bacteria in a less acidic vagina and tissue that’s more readily invaded…and guess what happens?” Yep, a pesky UTI. 

Weak pelvic floor muscles could also play a role

Another reason UTIs are more common as you age: “Emptying the bladder completely can be more difficult, which can also increase the risk of infection,” Goodall McDonald explains. 

Estrogen is again at play here. A lack of estrogen can weaken the pelvic muscles and supportive tissues, causing the bladder to prolapse, or descend into the vagina (4). This can make it harder to fully empty the bladder when urinating—and when urine stays stagnant in your bladder, it gives bacteria a chance to multiply and infect your urinary tract (5).

Stress incontinence, aka accidentally leaking urine when you laugh, cough, run, or lift things, is caused by weakened pelvic floor muscles and it’s also common in women who have given birth or, yes, gone through menopause. (6). Sure, incontinence can be a bit embarrassing, but it can also put you at risk for recurrent UTIs so be sure to mention bladder leakage issues to your OB-GYN (7).

What about UTIs during perimenopause?

During perimenopause, when your periods start to fluctuate but before you’ve officially reached menopause, you might start experiencing increased UTIs. It’s the same reasoning at play here, Goodall McDonald says. “In perimenopause, estrogen levels decrease, causing those tissue barriers to not work as well.”

Menopause Symptoms

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UTI Symptoms Before and After Menopause

While UTIs don’t always cause symptoms, you might be familiar with the telltale signs:

• A strong urge to urinate that doesn’t go away
• Pain or burning when urinating
• Urinating often, and passing small amounts of urine
• Cloudy or bloody urine, which may have a foul or strong odor
• Pressure or cramping in the lower abdomen or back (8)

“For some people in perimenopause and menopause, the symptoms are the same as pre-menopause: burning, pain, urinary frequency, blood in the urine,” says Goodall McDonald. However, UTIs can be harder to pinpoint in the elderly because they can manifest more atypically—for example, as delirium, confusion, dizziness, drowsiness, falls, urinary incontinence, or poor appetite (9). 

How to tell the difference between a UTI and Genitourinary Syndrome of Menopause (GSM)

There’s a somewhat new umbrella term for the wide range of symptoms (vaginal, vulvar, sexual, and urinary) that women experience during menopause: genitourinary syndrome of menopause (GSM), Minkin says (10). Recurrent urinary tract infections are one symptom of GSM, with others including burning, urgency, and frequency—in other words, what feels suspiciously like a UTI may not always be a UTI (11).

Your doctor will pinpoint what’s going on with a urine culture, rather than treating a UTI based on your symptoms alone. “If a person is having painful urination but the urine culture is negative for infection, GSM may be at play,” Goodall McDonald says. 

Treating UTIs During Menopause

Once your doctor has confirmed a UTI, the treatment will be the same during menopause as it was the very first time you got a UTI diagnosis: Antibiotics to clear the infection.

Antibiotics 

Goodall McDonald says the typical treatment for a UTI is antibiotics, and a urine culture will help your doctor determine the exact antibiotic you should take. (This may also depend on your age, other medications you’re taking, and your kidney function.) While you should start to feel better after a few days, finishing the full course will help prevent the infection from returning. 

If you deal with chronic or recurrent UTIs talk to your doctor about getting a prescription for antibiotics to have on hand when you start to feel symptoms. In some cases, they might also prescribe a low-dose antibiotic that can be used preventatively. 

Painkillers

Luckily, you don’t have to wait in pain while the antibiotics run their course—pain control is typically prescribed along with antibiotics, Goodall McDonald says. Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can also help.

Drinking water—and skipping coffee and alcohol 

Experts recommend avoiding coffee and alcohol if you’re dealing with a UTI, since both can be bladder irritants, Goodall McDonald says. “Both coffee and alcohol can mimic the symptoms of a UTI because they can cause urinary frequency and irritation,” she says. 

Instead, drinking lots of water dilutes your urine and lowers the concentration of bacteria in the bladder, making it less painful to go. Drinking water can also be helpful for preventing infections before they can begin by helping to flush out bacteria from your urinary tract. 

Why untreated UTIs are so dangerous

Yes, UTIs always seem to pop up at the worst, most inconvenient times, but putting off treating a UTI can cause serious health problems. While the infection most commonly develops in the bladder, an untreated UTI can spread to the kidneys, Goodall McDonald says. “A kidney infection is a systemic infection that can lead to kidney injury, sepsis, and even death,” she says, so it’s super important to get it treated (especially for the elderly).

If the infection has spread to your kidneys, symptoms may include: 

• Chills and shaking or night sweats
• Fatigue
• Fever above 101°F 
• Pain in the side, back, or groin
• Flushed, warm, or reddened skin
• Mental changes or confusion 
• Nausea and vomiting (12)

Menopause Relief

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How to Prevent UTIs During Menopause

The good news is that there are ways you can get ahead of this vicious cycle by talking to your OB-GYN about using vaginal estrogen, or even by simply drinking more water and properly wiping down there (front to back).

Vaginal estrogen for menopause UTIs

Vaginal estrogen, a form of hormone replacement therapy (HRT) (or sometimes just called hormone therapy), can help restore the normal bacterial balance of the vagina and prevent recurrent UTIs. 

“I encourage women to use vaginal estrogen if they are dealing with UTIs—it certainly helps,” Minkin says. Whether in the form of a cream, suppository, or ring inserted into the vagina, it’s estimated that vaginal estrogen can reduce your risk of UTIs by more than 75 percent (2). 

Plus, remember how the decline of estrogen can weaken the door that keeps bacteria out? “Vaginal estrogen can [thicken] the vulvar and urethral tissues so that they aren’t as thin and susceptible,” Goodall McDonald says. “It’s like beefing up security for the bladder.”

Vaginal gel

Minkin adds that while very few women truly can’t use estrogen, if they don’t want to use it, you might want to consider asking your doctor about a drugstore product like RepHresh Pro B, which helps maintain a more acidic environment and can provide protection against the bad bacteria that cause UTIs.

Practicing Good Bathroom Habits

Wiping front to back after any and every trip to the bathroom helps prevent the spread of bacteria from the anus to the vagina and urethra. This becomes more important in menopause since aging can cause mobility changes that make proper wiping techniques more challenging, Goodall McDonald says. 

Does cranberry juice help UTIs?

Goodall McDonald says cranberry juice contains proanthocyanidins (PACs), which help keep bacteria from sticking to the walls of the urinary tract. This might help prevent UTIs. 

One recent review of 50 randomized controlled trials concluded that ingesting cranberries as a juice, tablets, or capsules reduced the number of UTIs in women with recurrent UTIs (13). However, cranberry juice has a high sugar content, Goodall McDonald says (which can cause side-effects like an upset stomach and blood sugar spikes) and the research isn’t definitive on cranberry products preventing UTIs. 

Does D-mannose help UTIs?

D-mannose is a type of sugar found naturally in various fruits, including cranberries, grapes, watermelon, and apples. It works by attaching to the bacteria and preventing it from attaching to the cells in your urethra. However, there is currently little evidence showing that D‐mannose supplements can help prevent or treat UTIs, Goodall McDonald says (14). 

Does yogurt help UTIs?

Yogurt with probiotics, such as beneficial lactobacillus, can help support overall vaginal and urinary health by helping to maintain a normal pH in the vagina, Goodall McDonald says. 

However, there isn’t much strong evidence to show that yogurt alone, rather than taking a probiotic supplement, can help with recurrent UTIs. While it won’t necessarily lower your risk, it probably can’t hurt either (just look for low-sugar options), Goodall McDonald adds.