A common complaint women have as they age is an increased prevalence of urinary tract infections (UTIs). While in some cases, this can be linked to poor hygiene practices that allow bacteria to enter into the urethra and spread throughout the urinary tract, in other cases, it can be linked back to hormonal fluctuations, especially during menopause when estrogen levels begin to decrease.
A UTI is an infection somewhere within the urinary system, including the kidneys, ureters, bladders and urethra. Most commonly, they occur in the lower urinary tract, involving the bladder or urethra. They occur more commonly in women due to anatomical differences including the length of the urethra compared to men, and typically require antibiotics to treat them. Leaving them untreated can result in serious health complications, especially if the infection spreads into the kidneys.
While some UTIs can present without symptoms, they often can be identified by:
- A persistent urge to urinate, even after recently relieving yourself
- Frequently passing small amounts of urine
- Feeling a burning sensation while urinating
- Cloudy, red, pink or brown urine
- Strong-smelling urine
- Centralized pelvic pain
If you have symptoms of a UTI, the first thing to do is contact your usual health care provider. They can test your urine for bacteria and prescribe the correct antibiotics to alleviate the discomfort and treat the infection.
Why UTIs Occur
UTIs are incredibly common in women, accounting for around 25% of all infections. Over half of women develop at least one UTI during their lives, with one in three developing at least one UTI by age 24.
At its simplest, a UTI occurs because bacteria has entered the urinary tract and spread. While the urinary system is designed to be sterile, bacteria can sometimes enter the urethra and lead to infection. Most commonly, it is caused by Escherichia coli (E. coli), which can be introduced due to the close proximity to the anus in female anatomy. While other bacteria may cause UTIs, around 90% of infections can be linked back to E. coli.
Risk Factors of UTIs
Certain risk factors can increase the chances of developing a UTI. Some of these are female-specific while others are more general. Reasons women may develop a UTI include:
- Sexual activity, especially if introducing a new sexual partner
- Use of diaphragms or spermicide as birth control
More generally, people of either sex may be at a higher risk for developing a UTI if they:
- Have urinary tract problems that cause urine to back up into the urethra
- Have blockages in the urinary tract
- Have a suppressed immune system
- Use a catheter or have used a catheter recently
- Have recently had a urinary procedure
UTIs and Menopause
Menopause is the cessation of a woman’s menstrual cycle, diagnosed after 12 months without a menstrual period. While it can begin in a woman’s 40s, it’s typically diagnosed in the United States at age 51.
During menopause, women’s bodies go through a myriad of hormonal changes. These can cause symptoms such as:
- Hot flashes or chills
- Vaginal dryness
- Night sweats
- Sleep irregularities
- Thinning hair
- Weight gain
- Loss of breast fullness
- Dry skin
The hormone fluctuations responsible for menopause can also increase the risk of UTI for numerous reasons. Over 50% of postmenopausal women develop recurrent UTIs, which are diagnosed when a person has had at least two infections within a six-month window and three or more in the last year.
Decreasing Estrogen Levels and Vaginal pH
One reason menopause increases the risks of developing a UTI is because the hormonal fluctuations of menopause can change the pH of the vagina. Estrogen is a key hormone in protecting the urogenital tract from foreign bacteria. In a healthy vagina prior to menopause, the vaginal walls release glycogen, which lactobacillus bacteria ferment into lactic acid. The lactic acid inhibits the growth of foreign bacteria and keeps the vagina’s pH at the correct level.
When estrogen levels decrease, the population of the lactobacillus bacteria decreases as well, which means less lactic acid to prevent foreign bacteria from growing and a higher vaginal pH. The higher pH further hinders what remains of the natural lactobacillus colonies and foreign bacteria that can cause UTIs can develop. If that bacteria is introduced from the vagina to the urethra, such as wiping from back to front after using the restroom, an infection may occur.
Decreasing Estrogen Levels and Urinary Incontinence
These hormonal fluctuations can also result in the weakening of the pelvic floor. Estrogen levels naturally decrease dramatically during and after menopause, which can also weaken the pelvic floor muscles. Typically, pelvic floor muscles hold the bladder and other organs in place.
As the pelvic floor muscles weaken, women are at an increased risk of developing urinary incontinence, which causes small amounts of urine to leak involuntarily. Without proper hygiene, a UTI may develop because urine is not sterile. Urine contains low levels of bacteria and when it sits, the bacteria can multiply and cause an infection.
Are you Getting UTI's?
Managing Recurrent UTIs
While UTIs can be treated easily, they are still painful and uncomfortable when they occur. People who develop recurrent UTIs can reduce their risk by:
- Staying Hydrated: Drinking plenty of water can dilute urine and encourage frequent urination, both of which allow bacteria to be flushed out of the urinary system.
- Wipe From Front to Back: By wiping from front to back, the likelihood of introducing bacteria into the urethra from the vagina or anus is reduced.
- Urinate After Sex: During sex, bacteria can readily be introduced into the urethra. By urinating shortly after sex, the urethra is flushed out and the risk of a UTI is reduced.
- Be Mindful of Birth Control: Condoms with spermicide, unlubricated condoms and diaphragms can all increase bacterial growth in the vagina. Choose other methods of birth control to reduce the risk of a UTI.
- Skip the Feminine Products: While some women may turn to deodorant sprays, douches and powders to stay fresh in their genital area, these can potentially irritate the urethra and encourage the development of a UTI. Stick to cleaning the vaginal area with warm water, moving from front to back to reduce the likelihood of spreading bacteria.
- Don’t Hold Urine: Using the restroom any time the urge arises can prevent bacteria from growing within the urinary system and also flush bacteria out, helping reduce the risk of a UTI.
- Hormone Replacement Therapy: Bioidentical hormone replacement therapy can reduce many of the symptoms caused by menopause rapidly decreasing levels of estrogen in the body.
Boston Hormone Therapy From Hormonally Balanced
Menopause can wreak havoc in women’s lives and significantly affect their comfort. From complaints about sex and libido to increased levels of UTIs, decreasing levels of estrogen can affect multiple areas of a woman’s life. With bioidentical hormone replacement therapy, many of these symptoms can be alleviated.
While you may be seeking hormone therapy for menopause symptoms that are more frequent, such as insomnia or vaginal dryness, you may also see the frequency of UTIs decrease while enjoying the numerous benefits. Women who take estrogen often find that their moods stabilize and they generally feel a better sense of wellness.
At Hormonally Balanced in Boston, MA, women can receive hormone replacement therapy from an all-female team of practitioners. We offer a discreet community that encourages patients to feel relaxed and heard and handle a range of sexual health and anti-aging issues.
Just because menopause is a natural phase of life doesn’t mean that you have to accept all of the discomforts that come with it. If you think that you would benefit from hormone replacement therapy or if you have issues pertaining to perimenopause or menopause, contact Hormonally Balanced today so we can help you feel your best.