UTIs During Menopause: Why They Become More Common and What the Research Says About Vaginal Oestrogen
We often hear about hot flushes, night sweats and changes in sleep during menopause. But there's another common issue that doesn't get nearly enough attention: changes in bladder and urinary tract health. In fact, there's a term to describe these changes called the Genitourinary Syndrome of Menopause (GSM). GSM collectively describes the changes associated with declining oestrogen to the vulva, vagina, urethra and bladder.
For some women, this means suddenly experiencing frequent UTIs, even if they've never been particularly prone to them before. And unfortunately as is so frequently the case, women tend to suffer in silence. But perhaps you don't need to.
So here's what the research says and it may be something you haven't heard much about...
Why do UTIs become more common during menopause?
Oestrogen does more than regulate your menstrual cycle. It also plays an important role in maintaining the health of tissues surrounding the vagina, urethra (the tube that carries urine out of your body) and bladder.
As oestrogen levels fluctuate during perimenopause and decline after menopause, several changes can occur:
Changes to vaginal tissues: Lower oestrogen can make tissues thinner, drier and more vulnerable to irritation.
Changes to the vaginal microbiome: Oestrogen helps support beneficial bacteria called Lactobacillus, which help maintain an acidic vaginal environment. As oestrogen declines, these protective bacteria may decrease.
Changes to urinary tract function: The tissues surrounding the urethra and bladder can also be affected, contributing to symptoms such as urgency, frequency and discomfort.
Together, these changes can make it easier for bacteria to colonise the area around the urethra and potentially increase the risk or susceptibility of urinary tract infections.
What can you do about it?
There is some promising research into the use of vaginal oestrogen as an intervention for preventing recurrent UTIs in peri- and postmenopausal women.
Vaginal oestrogen is a low-dose hormonal treatment applied directly to the vaginal tissues, usually as a cream, tablet, pessary or vaginal ring.
It can help restore the health of vaginal and urethral tissues and support a more protective vaginal environment.
A 2020 systematic review and meta-analysis examined five randomised controlled trials involving 1,936 postmenopausal women.
Researchers found that women using vaginal oestrogen had a 58% lower relative risk of recurrent UTIs compared with women receiving placebo.
It's important to note that vaginal oestrogen is used for prevention, not as a substitute for antibiotic treatment of an active bacterial UTI.
It is different from systemic menopause hormone therapy (MHT) which has not demonstrated the same protective effect against recurrent UTIs as vaginal oestrogen.
This means that even women already using systemic MHT may benefit from discussing local vaginal oestrogen with their GP if they're experiencing recurring infections or other GSM symptoms.
Is vaginal oestrogen safe?
For most women, low-dose vaginal oestrogen is considered a safe and effective treatment for GSM.
Because it acts primarily on local tissues, systemic absorption is generally low, particularly with low-dose preparations.
Clinical guidelines recognise that low-dose vaginal oestrogen has a different risk profile from systemic hormone therapy.
For most women using low-dose vaginal oestrogen alone, additional progesterone is not routinely required to protect the uterine lining.
However, treatment decisions should always consider individual medical history. Women with a history of oestrogen-sensitive cancer, unexplained vaginal bleeding or other relevant medical conditions should discuss treatment with their GP or specialist.
Other ways to reduce your risk of UTI's.
1. Stay adequately hydrated
Drinking sufficient fluids helps maintain regular urine production and bladder function.
If you're someone who consistently drinks very little water, increasing your intake may help reduce recurrent UTIs.
However, more isn't always better, and individual fluid requirements vary.
2. Avoid holding urine for prolonged periods
Empty your bladder when you need to, rather than regularly delaying urination for long periods.
At the same time, avoid getting into the habit of urinating constantly 'just in case', which may contribute to urinary urgency.
3. Support your pelvic floor
Your pelvic floor muscles play an important role in bladder control and urinary function.
Strength training, regular physical activity and appropriate pelvic floor exercises can support overall pelvic health.
If you're experiencing leakage, urgency or difficulty emptying your bladder, a pelvic health physiotherapist can assess whether strengthening, relaxation or other strategies are most appropriate.
Pelvic floor exercises aren't a proven treatment for preventing bacterial UTIs, but they can help manage urinary symptoms that sometimes occur alongside GSM.
4. Consider your sexual health
Sexual activity can be a trigger for UTIs in some women.
Using adequate lubrication to reduce friction and irritation may improve comfort, particularly when vaginal dryness is present.
Urinating after sex is a commonly suggested precaution, although strong evidence that it prevents UTIs is limited.
5. Seek help for recurring infections
If you're experiencing two or more UTIs within six months, or three or more within a year, this is generally considered recurrent UTI.
Rather than repeatedly managing infections as isolated episodes, speak with your GP about prevention strategies, appropriate testing and whether vaginal oestrogen may be suitable.
Depending on your circumstances, other preventive options may also be considered.
The MenoMojo takeaway
While recurrent UTIs can become more common after menopause, they're not something you simply have to accept as part of getting older.
References and further reading
This article is intended for general education and does not replace individual medical advice. If you experience persistent or recurrent urinary symptoms, speak with your GP or appropriate healthcare professional. Seek prompt medical attention for symptoms such as fever, flank pain or feeling significantly unwell with a suspected UTI.
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