Many women experience more frequent urinary tract infections (UTIs) after menopause, yet a recent Canadian survey reveals that 82% of women do not realize these two are connected.
At the Sex, Gender and Women’s Health Research Hub, researchers are working to raise awareness and promote proven strategies to reduce UTIs among women in their later years.
Why Are UTIs More Common After Menopause?
The main reason UTIs increase after menopause is the drop in estrogen levels. Estrogen plays a key role in keeping the urinary tract healthy.
When estrogen levels fall, the lining of the urethra—the tube that carries urine out of the body—becomes thinner and more fragile. At the same time, the urinary tract loses infection-fighting blood cells, and the mucosal immune defenses that protect against bacteria are weakened.
These changes make it easier for bacteria to cause infections. Additionally, shifts in the natural vaginal bacteria that protect against infections leave the urinary tract more vulnerable.
Other factors also raise UTI risk after menopause. Weakened bladder muscles or pelvic organ prolapse can cause urine to stay in the bladder, allowing bacteria to multiply. Urinary incontinence can create a moist environment that promotes bacterial growth. While sexual activity does not directly cause UTIs, it may introduce bacteria into the urinary tract, increasing the chance of infection.
Recognizing UTI Symptoms
UTIs are diagnosed only when bacteria and symptoms are both present. Common symptoms include:
- A strong, persistent urge to urinate
- Burning sensation during urination
- Frequent urination in small amounts
- Pelvic discomfort or pressure
Severe infections can spread to the kidneys, so symptoms like fever, chills, or back pain require urgent medical attention.
In older women or those with conditions like dementia, UTIs may show up as confusion, withdrawal, or loss of appetite. However, sudden mental changes should always be evaluated by a healthcare professional, rather than assumed to be caused by a UTI.
Proven Ways to Prevent UTIs
Experts recommend several effective medical and lifestyle strategies:
Vaginal Estrogen Therapy
Applying small doses of estrogen directly to vaginal tissues through creams, tablets, or rings can restore protective barriers and reduce UTIs. This treatment is safe even for breast cancer survivors and differs from systemic hormone therapy.
Non-Antibiotic Medication
Methenamine hippurate, taken orally twice daily, helps prevent bacterial growth in the urinary tract. In Canada, this medication is available through compounding pharmacies.
Low-Dose Antibiotics
Doctors may prescribe lower-dose antibiotics for several months or use them after sexual activity if it triggers infections. However, antibiotics can have side effects and contribute to antibiotic resistance.
Dietary Supplements
Cranberry products may help prevent UTIs by stopping bacteria from sticking to the bladder lining, though research is mixed. Choosing products with high levels of active compounds (PACs) is recommended. Probiotics containing Lactobacillus may also support a healthy vaginal microbiome, but more studies are needed.
Hygiene and Lifestyle Habits
Simple habits can aid prevention:
- Drink plenty of water to flush bacteria
- Urinate regularly, avoiding holding urine for long periods
- Urinate after sex to clear bacteria
- Wear breathable cotton underwear and loose clothing to reduce moisture
When to Consult a Doctor
Women experiencing frequent UTIs—defined as two or more in six months, or three in a year—should speak with their healthcare provider. Together, they can develop a tailored prevention plan.
UTIs are not an inevitable part of aging. With the right medical care and lifestyle adjustments, women can effectively reduce their risk after menopause.
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