UTIs after menopause is common than people believe. 50-60% of adult women are likely to experience urinary tract infections at some point in their lives. While it has already been established that UTIs are more common in people with a uterus, owing to a shorter urethra, recent studies draw an association between post-menopause and increased risk of UTIs. It is suspected that this may be due to fluctuations in hormones.
Contamination of the male or female urinary tracts results in a urinary tract infection or UTI. This could either be a result of bacteria entering the urinary tract from the surrounding area or an imbalance of pre-existing bacteria in the vagina's flora.
In the case of UTI and menopause, UTI is caused because of a hormonal or chemical imbalance that alters the pH of the vagina. This results in the rapid growth of bacteria that already resides in the vagina. The rapidly proliferating bacterial colony soon makes its way up toward the urinary tract and may result in either of the two types of UTI. Infection that remains restricted to the lower urinary tract is called cystitis while that which extends to the upper urinary tract is known as pyelonephritis.
The stages of menopause can be divided into three categories. The first is known as perimenopause and may last from about 5 to 10 years between the ages of 45 and 55, depending on the woman’s health and genetics. For some women, perimenopause is very harsh on them. They experience hot flashes, severe lower back and pelvic pain, frequent mood swings, decreased libido, etc.
Perimenopause begins with the body producing less and less of the sexual hormones. Consistent decrease or random fluctuation in estrogen and progesterone levels is the main cause of most of the symptoms experienced by a woman nearing menopause. Changes in estrogen levels may alter the lining of the vaginal walls, disturbing flora. This increases the risk of bacterial growth and if not controlled, results in UTIs. Any form of unprotected sexual activity during this time may also make you more susceptible to contracting a UTI.
Eventually, around the age of 55, perimenopause enters the menopause phase. This is when the woman stops menstruating or experiences amenorrhea. While this puts the severe symptoms to rest, the woman is unable to conceive or carry a child.
Once the woman enters the postmenopausal phase, they are naturally exposed to a higher risk of developing UTIs. According to a 2019 study, more than 50% of postmenopausal females develop recurrent UTIs. With the progression of pre-menopause and eventual menopause, there is a great decrease in estrogen production. The extremely low estrogen levels in a post-menopause body cause the muscles of the urinary bladder and pelvic floor to weaken. This results in a small volume of urine escaping the body involuntarily, otherwise known as urinary incontinence. Urinary incontinence is a common cause of the development of UTIs.
With the progression through menopause, the chances of a person developing a urinary tract infection vastly increase. Most of these infections are characterized as recurrent UTIs. Recurrent infection is when a person has at least two infections during 6 months and 3 or more in the whole year. Changes in the urogenital microbiome due to decreased levels of estrogen reduce the body's natural defense mechanism against UTIs.
Lactobacillus is one of the bacteria that colonizes a healthy vagina before menopause. The carbohydrate glycogen released by vaginal walls is fermented by the lactobacillus into lactic acid. This acid plays a major role in inhibiting foreign bacteria and other pathogens from colonizing the urogenital tract.
Low estrogen levels fairly decrease the number of lactobacilli in the vaginal flora. Since the bacteria that previously protected the vagina is no longer available in enough quantities, the person is at a higher risk of developing recurrent UTIs. In addition to low levels of Lactobacilli, there is also a raised pH which further prevents the bacteria to work at their optimal rate. This combination lays a foundation for more urinary tract infections.
Other risk factors of post-menopausal women developing UTIs include a history of UTI before menopause, diabetes, increased sexual activity, and urinary incontinence due to weakened pelvic and bladder muscles.
From the beginning of menopause, the urethral lining starts thinning. Combined with the weakened bladder and pelvic muscles, the person develops urinary incontinence. The two main types of urinary incontinence are stress and urge incontinence.
Stress incontinence usually presents during perimenopause and may continue throughout the length of menopause and onwards. This is when any sort of stress, such as sneezing or laughing, on the bladder causes it to leak slightly. While this condition does not progress with the progressing stages of menopause, it is still a concern.
Urge incontinence is due to an overactive bladder where you feel a sudden and urgent need to urinate. The muscles of the bladder weaken to an extent that they are unable to hold even a slight volume of urine for long periods.
If you experience either or all of the three symptoms below, you likely have a urinary tract infection and should visit a doctor.
While in pre-menopausal women, UTIs can be treated with home remedies such as cranberry juice or other OTC medications, postmenopausal women are mostly treated with antibiotics. Your doctor is likely to ask for a Urine Detailed Report to identify the presence of any bacteria in your urinary system and a urine culture report to identify the colony of bacteria present. Identifying the colony of bacteria is important for prescribing the right antibiotic that specifically targets the bacteria present inside your urogenital tract.
With growing concerns regarding bacteria becoming resistant to antibiotics, healthcare professionals repeatedly stress the importance of completing the entire antibiotic dosage. The antibiotic needs to be continued for as long as the prescribed dosage, even after the symptoms have subsided.
Frequent urination and drinking plenty of water daily speed up your recovery process. While the antibiotics do their job, the large amount of water consumption allows you to flush out the bacteria from your body frequently. Most people even resort to using non-steroidal anti-inflammatory drugs or NSAIDs to relieve pelvic pain symptoms of UTI after menopause.
While you may not be able to prevent every UTI infection once you start experiencing recurrent UTIs, there are ways with which you can fairly reduce the severity of their symptoms. These include:
Are you a woman nearing menopause and want to prevent UTIs in the future? Worry no more! At Family Medicine Austin, we offer a comprehensive preventative and diagnostic management service for you and your family. Reach out to us today and avail of our full spectrum of healthcare services!