Getting a UTI can be a pain for women of any age, but women post-menopause are especially at risk of developing a urinary tract infection.

The prevalence of lower UTI (also known as cystitis) in women increases with age, and up to 15% of women over the age of 60 will develop recurring UTIs.1

Many older women believe that urinary symptoms such as needing to go to the toilet a lot, or continence issues, are just a normal sign of aging.1 Also, scientific research into women’s health issues is lacking, and there is still a lot we don’t know about the causes and mechanisms of certain illnesses. Healthcare providers often don’t have answers when it comes to chronic conditions, leave their female patients in the dark, and show a lack of empathy and understanding. For these reasons, it is understandable why you might put off a visit to the doctor about urinary symptoms.2

But these symptoms could be a sign of UTI, and UTI shouldn’t be ignored, so it is important that you get appropriate care and the treatment that you need.

What are the signs of UTI?

Common signs of a UTI include cloudy urine, a burning or stinging feeling when you pee, abdominal pain, and needing to go to the toilet more urgently and more often than usual.3

Incontinence can also be a sign of cystitis, although it is also a very common issue in women, becoming more prevalent with age, and is not necessarily indicative of an infection.

Up to 60% of women report at least some incontinence, and studies have found that around 70% of women first start to experience urinary incontinence following their final menstrual period.1

That being said, if you experience symptoms, like cloudy wee or pain when peeing, that are not normal for you and you think that they might be cause for concern, it is a good idea to check for UTI by taking an at-home urine test. 

You can do this with the TestCard UTI test kit (available at Amazon.com, TestCard.com or at Superdrug.com). We understand how debilitating a urine infection can be, but with TestCard you can take a urine test and get the results from the comfort of your home, and if your results are positive you can also use our treatment partner to get antibiotic treatment delivered straight to your door. 

However, if your symptoms become more severe or you begin to experience signs of a kidney infection (e.g. vomiting, fever, chills), it is important that you seek help from a medical professional straight away.

The connection between menopause and UTI

For menopausal or post-menopausal women, the most reported factors that can increase the chance of developing cystitis include living with another chronic condition such as diabetes, having a history of urine infections before menopause, having a family history of UTI, and having structural abnormalities in the pelvic area.4,5

Find out more about what else can contribute to the development of UTIs here: Why do I keep getting urinary tract infections?

However, the risk factor that is discussed most often is the decline of oestrogen which occurs with menopause. The decline of the hormone oestrogen has a significant impact on the functioning of the urinary tract. So let’s look at how this is connected to urinary tract infections...5

What does having lower oestrogen mean?

First of all, lower quantities of oestrogen are associated with a number of anatomical changes1:

  • The urethra (the tube that carries urine from the bladder out of the body) becomes shorter
  • The lining of the urethra becomes thinner
  • The muscle that controls urine leaving the bladder becomes less efficient
  • The bladder becomes less capable of holding large amounts of urine
  • The muscles of the vagina and the muscles of the pelvic floor lose volume

These changes interfere in different ways with the passing of urine through the urinary tract and out of your body, therefore increasing the chance of infection occurring. 

They also increase the risk of continence problems, as well as pelvic organ prolapse (when one of the organs in the pelvic area moves down and presses against the vagina), which in turn also increase the risk of UTI.6

What is Lactobacillus?

Also, as well as anatomical changes, lower oestrogen levels have an important effect on the bacteria living in the urinary tract. Oestrogen helps with the production of glycogen. This is very important because glycogen is food for Lactobacillus (good bacteria). Therefore, less oestrogen means less glycogen, which means less food for good bacteria to grow and thrive. And that good bacteria is needed to create a protective environment.7

Without as much Lactobacillus, harmful bacteria are more likely to invade the urinary tract and cause an infection.

To put this in perspective, one study found that when looking at urine samples from premenopausal women, Lactobacillus accounted for 78% of bacteria in the sample, whereas for post-menopausal women it was found that Lactobacillus accounted for only 42% of the bacteria in the urine sample.8

This is why having lower oestrogen levels is one of the most significant risk factors for cystitis in post-menopausal women.

UTI treatment post-menopause

So we have an idea of what UTI looks like, and why it is more prevalent in older women. But what do you do if you get a urine infection? And how can you prevent a UTI from happening in the first place? Let’s look at some treatment and prevention methods.

Antibiotics are the most used treatment for urinary tract infections, but how long do antibiotics take to work?

Nice (the National Institute for Health and Care Excellence) recommends a 3 day course of antibiotics for a one-off UTI,9 and for recurrent UTI they recommend regular use of antibiotics to prevent further infections (antibiotic prophylaxis).10

However, for post-menopausal women, before prescribing antibiotic prophylaxis, it is recommended that doctors first prescribe oestrogen. 

As we have already discovered, having low oestrogen levels greatly increases the likelihood of developing cystitis because of its effect on Lactobacillus. But introducing oestrogen to the body (normally as a pill, a cream, or a ring inserted directly into the vagina)7 is shown to increase the amount of Lactobacillus in the vagina and urinary tract. Therefore, using oestrogen as a prevention technique has the potential to significantly reduce the risk of UTI.11

Treating a UTI without antibiotics

If you keep getting urine infections and using oestrogen has not worked, do you have to take antibiotics? You may be concerned about antibiotic use, and for good reason. If you take antibiotics too often your body builds up resistance to them, and then it can become harder to fight future infections. Some people also experience unpleasant side effects with antibiotics.

Some studies show that it is possible for urine infections to resolve on their own, without antibiotic treatment.12 However, it is also possible for an infection to worsen and spread to the kidneys if left untreated.

So if you have symptoms which are really bothering you, it is important to do a urine test, which you can do with the TestCard UTI test kit, to get a better idea of whether you may have an infection. Then you can decide on the best treatment for you.

How to prevent UTI post-menopause

There are a number of non-antibiotic home remedies you can try to prevent urine infections from happening in the first place. Let’s look at a few.

Cranberries

How does cranberry juice help UTI? Cranberries contain something called a proanthocyanidin, which stops bacteria attaching to the walls of the urinary tract. Cranberries are also an anti-inflammatory, meaning they can prevent the development of symptoms. However, their effectiveness for women post-menopause is still under debate. A recent review found no significant effect for the use of cranberry to prevent UTI, which means they cannot be recommended.6 But if you get UTIs frequently, it is always worth exploring prevention options to find what works for you.

D-mannose

D-mannose is another commonly used supplement to prevent UTI. It has been found that for postmenopausal women, urinary symptoms can be significantly improved with D-mannose.6 It is even suggested that taking D-mannose is almost as effective as using antibiotics preventatively.13 Similar to cranberries, it works by stopping bacteria from sticking to the walls of the urinary tract.14

Probiotics

Using probiotics for UTI is also an option. They have a different effect, as rather than deterring harmful bacteria, they help the growth of good bacteria (Lactobacillus).6 However, it has been suggested that definite conclusions cannot be made about their efficacy. 

Levels of Lactobacillus can also be improved by13:

  • Stopping smoking
  • Avoiding vaginal moisturisers
  • Not douching
  • And avoiding products containing spermicide

Also, a few studies have assessed the effects of Lactobacillus-containing suppositories, and patients reported different levels of success.14

Vitamin D

Lastly, Vitamin D works against UTI by strengthening the immune response of the bladder,6 and research has shown that for post-menopausal women taking Vitamin D, urinary symptoms were significantly less severe.14

As well as using these home remedies for UTI, there are a number of other tricks which are good to get into the habit of using if you are looking to prevent UTI post-menopause. For example, peeing after sex and avoiding very tight clothing.5 Find out more here.

References

1Alperin, M., Burnett, L., Lukacz, E., & Brubaker, L. (2019). The mysteries of menopause and urogynecologic health: clinical and scientific gaps. Menopause (New York, NY), 26(1), 103.

2Bradway, C., Coyne, K. S., Irwin, D., & Kopp, Z. (2008). Lower urinary tract symptoms in women—a common but neglected problem. Journal of the American Academy of Nurse Practitioners, 20(6), 311-318.

3https://www.nhs.uk/conditions/urinary-tract-infections-utis/

4Raz, R., Gennesin, Y., Wasser, J., Stoler, Z., Rosenfeld, S., Rottensterich, E., & Stamm, W. E. (2000). Recurrent urinary tract infections in postmenopausal women. Clinical Infectious Diseases, 30(1), 152-156.

5Baker, J. (2018). Challenges of Treating Urinary Tract Infections in Post-Menopausal Women. Urologic Nursing, 38(1).

6Caretto, M., Giannini, A., Russo, E., & Simoncini, T. (2017). Preventing urinary tract infections after menopause without antibiotics. Maturitas, 99, 43-46.

7https://liveutifree.com/uti-and-menopause/

8Ammitzbøll, N., Bau, B. P. J., Bundgaard-Nielsen, C., Villadsen, A. B., Jensen, A. M., Leutscher, P. D. C., ... & Sørensen, S. (2021). Pre-and postmenopausal women have different core urinary microbiota. Scientific reports, 11(1), 1-10.

9https://www.nice.org.uk/guidance/ng109/resources/visual-summary-pdf-6544021069

10https://www.nice.org.uk/guidance/ng112/resources/visual-summary-pdf-6544163629

11Chen, Y. Y., Su, T. H., & Lau, H. H. (2021). Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials. International Urogynecology Journal, 32(1), 17-25.

12Christiaens, T. C. M., De Meyere, M., Verschraegen, G., Peersman, W., Heytens, S., & De Maeseneer, J. M. (2002). Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. British Journal of General Practice, 52(482), 729-734.

13Jung, C., & Brubaker, L. (2019). The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric, 22(3), 242-249.

14Oberg, J., Verelst, M., Jorde, R., Cashman, K., & Grimnes, G. (2017). High dose vitamin D may improve lower urinary tract symptoms in postmenopausal women. The Journal of steroid biochemistry and molecular biology, 173, 28-32.