Frequent urges to rush to the bathroom or pain when urinating could signal a dreaded urinary tract infection (UTI). While they become more common with age, if you experience chronic UTIs (three or more per year), perimenopause may be to blame. Doctors say that fluctuating hormone levels significantly affect the vaginal environment, which can result in more bad bacteria getting into the urinary tract. Here, discover the connection between perimenopause and chronic UTIs, plus how to manage your symptoms and prevent future flare-ups.
What are chronic UTIs?
“A chronic UTI is a bacterial infection in the bladder or urethra that continues to persist or recur despite antibiotic treatment,” says Kate McLean, MD, MPH, FACOG, ob-gyn and chief medical officer at Evvy. “Factors such as perimenopause, a medical history of urinary tract infections, vaginal douching and certain contraceptives with spermicide can also make it easier to develop a urinary tract infection and increase the likelihood of recurrence.”
These occur when bacteria known as E. Coli enter the vaginal microbiome and multiply in the urethra (the tube where urine exits the bladder) and urinary tract. If you have three or more UTIs in one year or more than two in six months, it’s considered chronic, says Pamela Tambini, MD, a double board-certified physician in internal medicine and addiction medicine and medical director at Southeast Detox.
Symptoms of a UTI
Common symptoms of a UTI include:
- Discomfort, stinging or a burning sensation when you urinate
- A frequent, sudden need to urinate
- A constant feeling that you need to urinate, even when your bladder is empty
- Pain in your lower abdomen
- Strong-smelling urine
- Cloudy urine that may have blood in it
Dr. Tambini says some less common, but more severe, symptoms are a fever or chills (indicating a potential kidney infection), back pain, fatigue or feeling unwell. “If you’re experiencing these symptoms frequently, it’s essential to investigate what’s causing the recurrence,” she adds.
How perimenopause increases the risk of chronic UTIs
Similar to how hormone changes during perimenopause can cause hot flashes, night sweats or a low libido, they can also impact the vaginal environment and create conditions that make UTIs more likely. Dr. Tambini notes that vaginal dryness, loss of protective bacteria and weaker pelvic floor muscles (which can make it harder to empty the bladder fully) all contribute.
Women in perimenopause get nearly twice as many UTIs
The incidence of urinary tract infections is approximately double for women in perimenopause and menopause because of declining estrogen levels, Dr. McLean says. This dip in protective estrogen causes decreased levels of glycogen that feed and maintain healthy levels of protective bacteria, she adds, which increases the risk of developing a UTI. .
- “When there are lower levels of protective bacteria in the vagina, that can allow disruptive microbes that cause UTIs to flourish there and travel from the vagina to the urethra, causing infection,” says Dr. McLean.
- What’s more, “the vaginal and urinary tract lining becomes thinner and more fragile, making it easier for bacteria to invade,” Dr. Tambini adds. And the final culprit behind chronic UTIs in perimenopause: vaginal dryness. “This increases susceptibility to irritation and infections,” says Dr. Tambini.
How to prevent chronic UTIs during perimenopause
If you have an existing infection, you’ll first need to visit your doctor. He or she will typically perform a urine culture and prescribe a course of antibiotics to treat the UTI. Once the infection clears up, you can help prevent UTIs from recurring during perimenopause by following these smart tips:
- Drink plenty of water. Dr. Tambini says drinking water daily can help flush bacteria from your urinary tract. Aim to drink about half your body weight in ounces of water each day.
- Consider vaginal estrogen. This is a type of hormone replacement therapy (HRT) that’s available as a flexible ring, insert or cream that’s applied inside the vagina. “It’s been shown to normalize the vaginal flora and prevent recurrent UTIs,” says Dr. McLean. She says to consult your doctor before starting hormone therapy.
- Take probiotics. Probiotics containing lactobacilli (a beneficial bacteria) support healthy vaginal flora. They can be taken orally or vaginally, says Dr. Tambini.
- Sip unsweetened cranberry juice. Or take cranberry supplements. “While research is mixed, cranberries may prevent bacteria from adhering to the bladder lining,” says Dr. Tambini.
- Practice good hygiene. We know you already know this, but it bears repeating: Always wipe from front to back. If you’re douching or using anything with spermicide, it’s best to stop, as they can increase the risk of frequent UTIs, explains Dr. McLean.
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
