Struggling with UTIs after menopause? Experts say this can make a difference
After menopause, urinary tract infections (UTIs) can be more frequent, yet most Canadian women (82 per cent in a recent survey) don't realise the two are associated.
At the Sex, Gender and Women's Health Research Hub, our team's advocacy aims to increase awareness and highlight proven strategies to help prevent UTIs for women later in life.
Why are UTIs more common after menopause?
The main culprit for increased UTIs in menopausal women is the drop in estrogen levels. Estrogen plays a crucial role in maintaining urinary tract tissue health.
As estrogen declines, the lining of the urethra — the tube through which urine flows out of the body — becomes thinner and more fragile. Also, there are fewer infection-fighting blood cells in the urinary tract, and mucosal immunity — the specialised immune defences present at the mucosal surfaces lining the urinary tract that include physical and chemical barriers, cellular receptors and antibodies — is reduced.
This weakens the local immune response, making it easier for bacteria to cause infections. Additionally, changes in vaginal flora — the bacteria that naturally protect against infections — results in the urinary tract being vulnerable.
Other factors can contribute to UTI risk at this stage of life, too. Women whose bladder muscles have weakened with age, or who have developed pelvic organ prolapse, can experience incomplete bladder emptying. This leads to urine retention and an increased chance of bacterial growth.
Similarly, if women experience urinary incontinence, the leakage and moisture on incontinence pads or underwear can create an environment where bacteria thrive. And while sexual activity itself does not directly cause UTIs, it can introduce bacteria into the urinary tract, increasing the risk of infection.
Signs of a UTI
Bacteria in the urine without symptoms are called asymptomatic bacteriuria. It is not a UTI and should not be treated; a UTI is only diagnosed when bacteria and symptoms are both present. The most obvious symptoms include:
A new, strong, persistent urge to urinate;
A burning sensation while urinating;
Frequent urination in small amounts;
Pelvic discomfort or pressure.
In severe cases, UTIs can lead to kidney infections, so when symptoms include fever, chills and back pain, it is essential to seek immediate medical attention.
For women in their 80s or older, or sometimes younger women who are living with medical conditions such as dementia, urinary tract infections can manifest as behavioural changes such as confusion, withdrawal or reduced appetite. However, new-onset delirium should always be investigated by a medical team rather than assumed to be a UTI.
Evidence-based strategies to prevent UTIs
Several medical and lifestyle interventions can make a significant difference:
1. Vaginal estrogen therapy
One of the most effective ways to prevent recurrent UTIs in postmenopausal women is vaginal estrogen therapy, which delivers small doses of estrogen directly to the vaginal tissues through creams, tablets or rings.
Studies have shown that vaginal estrogen can restore the natural protective barrier of the urinary tract, reducing UTI risk significantly. It can be used by breast cancer survivors as it does not have the same risks associated with menopause hormone therapy (MHT).
2. Non-antibiotic prevention
Methenamine hippurate (one gram orally, twice a day) is effective in reducing UTIs by creating an environment that prevents bacterial growth. In Canada, women need to obtain this medication from a compounding pharmacy.
3. Low-dose antibiotic
Doctors may prescribe low-dose antibiotics – about half the standard dose – for several months. If sexual activity is a trigger for UTIs, antibiotics can be used episodically after sex. However, antibiotics can cause side effects and create antibiotic-resistant bacteria.
4. Diet supplements
Scientific evidence on consuming cranberry-based products to prevent UTIs is mixed. Some studies suggest that certain compounds in cranberries (proanthocyanidins, or PACs) prevent bacteria from adhering to the bladder lining, while others show no benefit. If trying these products, women should choose brands with high concentrations of PACs, the active ingredient.
Similarly, probiotics, especially those containing Lactobacillus strains, may help maintain a healthy vaginal microbiome, which in turn can lower UTI risk. However, research is still evolving.
5. Hygiene and lifestyle habits
Though there is limited evidence, simple everyday habits may help in preventing UTIs:
Staying hydrated – Drinking water helps to flush bacteria from the urinary tract. For women who drink a low volume of fluids each day (less than 1.5 litres), increasing water intake may help.
Urinating regularly – Avoid holding urine for long periods and aim to void every three to four hours during the day.
Urinating after sex – This helps clear bacteria introduced during intercourse.
Choosing breathable underwear – Cotton underwear and loose-fitting clothes reduce the buildup of moisture, which in turn reduces bacterial growth.
More innovations on the horizon
Vaccines are one of the most promising developments for preventing recurrent UTIs.
In one early trial, overall recurrences decreased by 75 per cent for women given an oral vaccine, with no major side effects reported.
Trials are currently underway in Canada, and researchers hope vaccines will provide a more effective and long-term solution.
When to see a doctor
Any woman who is experiencing frequent UTIs — defined as two infections in six months or three in a year — in menopause should talk to their doctor or primary care provider.
Together, they can determine the best preventive targeted strategies.
Knowledge is power, and there is more information available today than ever before. UTIs are not an inevitable part of ageing. With the right combination of medical treatments and lifestyle changes, women can reduce postmenopausal risk.
Erin A. Brennand is a Gynecologist & Associate Professor in the Cumming School of Medicine at the University of Calgary. Jayna Holroyd-Leduc is a Professor and Head in the Department of Medicine, Cumming School of Medicine at the University of Calgary. Pauline McDonagh Hull is a PhD Candidate in the Department of Community Health Sciences, Cumming School of Medicine at the University of Calgary.
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