UTIs and the Menopause

By Dr Ornella Cappellari

Urinary Tract Infections (UTIs) represent a very common infection among women.

The prevalence is higher in women than men mostly due to the anatomical differences between the two. There are many causes: for example bacteria (usually E.Coli that lives in our gut) that enters the urethra. Bacterial infection in the bladder can be caused by improper cleaning after using the toilet, having anal sex, the use of a diaphragm (a thin contraceptive cap fitting over the cervix) that prevents your bladder from emptying completely thus increasing the likelihood of growing bacteria, and finally and perhaps most pertinently, menopause.

During menopause, UTIs are fairly common. This is because the menopause causes hormonal changes in your body

It is vital that a UTI is treated as if it spreads to the kidneys, it could require hospitalisation. It is fairly common that UTIs do not respond to treatment or keep recurring. At the moment, the gold standard has been the use of antibiotics but antibiotic resistance is a growing phenomenon therefore making it necessary to understand the real cause of the recurrent UTI or find alternative therapies. Antibiotics can also lead to an unbalance of the bacteria living in our gut which in itself can lead to separate problems.

During menopause, UTIs are fairly common. This is because the menopause causes hormonal changes in your body which can cause a change in the bacterial balance in the environment of your vagina. Moreover, the urethra, like the vaginal wall, undergoes changes during the menopause, causing an increasing in your susceptibility to UTIs.

Common UTI symptoms are:

  • Having the urge to urinate often
  • Feeling discomfort or a burning sensation during urination
  • Leakage of urine in some situations (stress incontinence)

UTIs are usually diagnosed through a urine sample test. There are many treatments available but the most common is antibiotics. When the infection is recurrent, doctors may prescribe low dose/long term use of antibiotics. As mentioned, antibiotics have side effects. For menopausal women, many studies suggest the use of estrogen treatment delivered vaginally. It has been demonstrated that estrogen encourages the production of natural antimicrobial substances in the bladder. Moreover, they act on the bladder lining (the tissue is “stronger” because estrogen helps close the gaps between cells that line the bladder) therefore making it harder for bacteria to penetrate the deep layers of the bladder wall. They also prevent excessive cell shedding. Shedding can be a natural phenomenon during infections (you have the immune response and some cells die and then shed) but too much shedding can cause the bacteria to enter the deeper layer of the tissue so exfoliation is a double-edged sword.

It has been demonstrated that estrogen encourages the production of natural antimicrobial substances in the bladder.

Topical estrogen seems to be much safer than systemic estrogen as only about 1% of it goes into the system. Another recent study with Ospemifene, which is a selective estrogen modulator used to treat dyspareunia (pain during sex), showed good results. Ospemifene has been found to build back vaginal epithelieum which helps with the pain during sexual intercourse but also has been found to decrease UTI recurrence. Ospemifene though, being taken orally, can have all the problems relates to hormone substitutes (increased risk of breast cancer/cardiovascular diseases). Another promising study in 2012 suggests the use of lactobacilli to prevent recurrent UTIs.

Natural remedies include cranberry juice, however, this cannot be taken alongside blood thinning drugs. It also is suggested to drink plenty of fluids, use a vaginal lubricant in case of dryness and avoid overfilling the bladder.

In conclusion, the best pharmacological treatment to substitute long antibiotics course up to now seems to be topical estrogen.

Sources:

Obstet Gynecol. 2014 Dec;124(6):1147-56. doi: 10.1097/AOG.0000000000000526. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review.

Rahn DD1, Carberry C, Sanses TV, Mamik MM, Ward RM, Meriwether KV, Olivera CK, Abed H, Balk EM, Murphy M; Society of Gynecologic Surgeons Systematic Review Group.

Arch Intern Med. 2012 May 14;172(9):704-12. doi: 10.1001/archinternmed.2012.777.

Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women.

Beerepoot MA1, ter Riet G, Nys S, van der Wal WM, de Borgie CA, de Reijke TM, Prins JM, Koeijers J, Verbon A, Stobberingh E, Geerlings SE.

Bladder infection (urinary tract infection — UTI) in adults. (2013).
niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/Pages/ez.aspx

Kodner CM, et al. (2010). Recurrent urinary tract infections in women: Diagnosis and management.
aafp.org/afp/2010/0915/p638.html

Mayo Clinic Staff. (2015). Urinary tract infection (UTI).
mayoclinic.org/diseases-conditions/urinary-tract-infection/basics/definition/con-20037892

Urinary tract infection (UTI). (n.d.)
plannedparenthood.org/learn/womens-health/utis


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