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How to prevent UTIs in menopause

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Are you a woman in menopause or perimenopause? If so, you may experience urinary tract infections (UTIs) more frequently than when you were younger. This is due to changes in your body caused by menopause.

If you’re experiencing frequent UTIs, you may be wondering what’s triggering your UTI and how you can prevent a UTI naturally without having to resort to endless doctor’s visits and rounds of antibiotics.

In this article, we’re focused on helping women in perimenopause and menopause understand what’s causing frequent UTIs and how to prevent them.

We’ll review what are the hormonal changes that cause frequent UTIs, how vaginal estrogen works to prevent and greatly reduce the risk of UTIs, and talk about other UTI prevention tips that are not shown to be as effective as vaginal estrogen but that may be worth trying.

What are common UTI risk factors for older women?

Women of all ages experience UTIs. But studies have shown that older women are more likely to get a UTI and suffer from recurrence than younger women.

Common UTI risk factors for older women include:

  • Perimenopause
  • Menopause
  • Changes in vaginal pH
  • Vaginal atrophy

UTI risk factors for older women in particular are related to changes in hormone levels. But what’s the connection exactly? It all starts with declining estrogen levels in perimenopause and menopause. Declining estrogen levels lead to vaginal atrophy and changes to vaginal pH. And these changes can lead to frequent UTIs.

Vaginal atrophy can include a constellation of symptoms that affect the entire vulva:

  • Frequent UTIs
  • Pain or burning with urination
  • Urgency to pee
  • Vaginal dryness
  • Vaginal burning
  • Shortening and tightening of the vaginal canal
  • Painful sex

If this sounds familiar, then rest assured you are not alone. Vaginal atrophy is a natural part of menopause and aging - up to 90% of post-menopausal women have been shown to have at least one symptom of vaginal atrophy.

This is where vaginal estrogen comes into play as it can reverse vaginal atrophy and restore balance to the vagina's flora - which helps to prevent UTIs.

4 Ways to Prevent UTIs in Menopause

UTIs can be difficult to prevent when you’re older - especially when all of the things you did when you younger (like peeing after sex, practicing good hygeine, and drinking lots of water) don’t seem to work anymore.

So, once you’ve cleared a UTI, what else can you do you to prevent one from happening again? Here are the top 4 ways ways to prevent UTIs, with the clinical studies to back them up.

1. Vaginal estrogen

Vaginal estrogen is one of the most effective treatments for preventing frequent UTIs that are related to menopause.

Vaginal estrogen acts to prevent UTIs in two ways. First, it helps restore the normal balance of bacteria in the vagina. Second, it restores moisture and plumpness to skin in and around the vagina. Now let’s dig into this a little more.

Why is it important to restore the normal balance of bacteria in the vagina?

The hormone estrogen is naturally produced by your body and allows good bacteria in the vagina to thrive. But falling estrogen levels in peri-menopausal and menopausal women can cause a shift in vaginal PH. More specifically, your body struggles to balance the levels of good bacteria (lactobacilli) and bad bateria (E. coli) in your vagina. And since your vagina is located close to your urethra, E. coli can enter the urinary system and cause infection. But you can prevent this with vaginal estrogen. Vaginal estrogen works with your body to help the good bacteria thrive again - and this can prevent UTIs.

Why is it important to keep the vaginal skin healthy?

In addition to promoting balanced vaginal flora, estrogen keeps the skin in and around the vagina moist and plump and healthy. But declining estrogen levels in perimenopause and menopause can cause changes to the labia and urethra. For example, if you’ve noticed that your labia have become smaller, then your urethra could be more exposed to infection. And if E. coli is present in the vagina, then you could be facing a situation where bacteria from the vagina can more easily enter the urinary system and cause an infection.

There are two types of vaginal estrogens available on the market - one that’s created from estradiol and one that’s created from the urine of pregnant mares. You can apply vaginal estrogen directly to the vulva or vagina, insert it in the vagina as a suppository, or slowly release it from a ring worn inside of your vagina.

How long do you need to use vaginal estrogen? Think of it like sunscreen - which helps prevent sun damage. You’ll need to use vaginal estrogen for as long as you want to prevent UTIs. And if you stop using vaginal estrogen, symptoms are likely to return.

In addition to helping prevent UTIs, vaginal estrogen can also help relieve menopause symptoms such as vaginal dryness and pain during intercourse. So not only does it provide protection from uncomfortable infections, it also helps make sex more enjoyable again!

2. D-mannose

In 2020, a review of several studies concluded that D-mannose was as effective as antibiotics at preventing UTIs.

Studies show that repeated use of antibiotics, including low-dose antibiotics to prevent UTIs, can cause antibiotic resistance. If you’re looking for an alternative to antibiotics, you might consider D-mannose.

D-mannose is found in fruits like cranberries and oranges. It’s available over the counter and is taken as a pill or a powder. You can use D-mannose as long as you need to prevent UTIs. Your body won’t develop a resistance to it.

Unlike vaginal estrogen which balances the vaginal flora, D-mannose works by flushing bacteria out of the urinary tract. It binds with E. coli bacteria and as a result, the E. coli can no longer attach themselves to the urinary system and cause infection.

In order to prevent bacteria from causing infection in your urinary system, you’ll need to take D-mannose 1 or 2 times a day.

3. Cranberry juice

Cranberry juice is a popular home remedy to prevent UTIs, but studies show is isn’t as effective as other options.

If you’re using cranberry juice to prevent UTIs, studies show that 8-10 ounces per day may be effective.

4. Vaginal probiotic supplement

Some studies have shown that vaginal probiotics can help balance bacteria in the vagina and prevent urinary infection, but more research is needed.

Vaginal probiotic supplements are marketed as a way to introduce good bacteria into the vagina and promote healthy pH balance. When it comes to how to take vaginal probiotic supplements, you have options. This includes both probiotic pills and suppository capsules that are inserted into the vagina using an applicator - both of which can be purchased over the counter.

Keep in mind that vaginal probiotic supplements, unlike vaginal estrogen, are not FDA-regulated. And compared to other forms of prevention like vaginal estrogen, there is little evidence to suggest that vaginal probiotics can prevent UTIs.

If you do want to try a vaginal probiotic supplement, consider one that contains Lactobacillus. Studies show that this particular bacteria may prevent UTIs in younger women, but more studies need to be done that include older women.

How To Get Help Preventing UTIs

While UTI prevention strategies such as drinking plenty of water, wearing loose clothing, and urinating regularly may help prevent UTIs, you may find that you continue to experience UTI symptoms.

Some women may turn to solutions like cranberry juice or supplements - but these solutions have little evidence and are not rigorously tested by the FDA.

If you want to prevent recurring UTIs, prescription treatment with vaginal estrogen may be a better option. Talk to a medical provider about your symptoms and see if a prescription for vaginal estrogen could help.

Without treatment, UTIs can cause complications, so it’s better to get help sooner rather than later. And, by taking preventive measures, you can protect yourself against pain and discomfort while enjoying life at any age!

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