Females experiencing menopause may be more likely to develop urinary tract infections (UTIs). This may be due to a combination of hormonal changes and the female anatomy.

UTIs are one of the most common infections, and they occur when bacteria, or other microbes, contaminate the urinary tract and reach the bladder.

Contamination occurs when bacteria from the surrounding area, including the rectum and vagina, enter the urethra, which is the tube through which urine exits the body.

Females are more likely to get UTIs than males. Estimates suggest that about 60% of females will have at least one UTI during their lifetime compared with 12% of males. Anatomically, females have shorter urethras than males, meaning that the bacteria have less distance to travel to reach the bladder.

Medically speaking, females reach menopause 12 months after their last menstrual cycle. However, the term can also describe the years leading up to this transition, as well as the years after it.

This article explains the effects of menopause on the urinary tract. It also explores the reasons why females are more susceptible to UTIs during and after menopause and suggests ways to prevent these infections.

An older woman who is experiencing menopause and a UTI.Share on Pinterest
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From start to finish, the transition to menopause, known as perimenopause, takes years to complete. The National Institute on Aging says that although it lasts 7 years on average, it can sometimes be double that. The age at which it starts also varies among individuals, but it is usually between the ages of 45 and 55 years.

During perimenopause, the ovaries produce less estrogen and progesterone. These hormones play an important role in females’ reproductive and sexual health.

According to the Urology Care Foundation (UCF), fluctuations in estrogen levels can change the lining of the vagina, and harmful bacteria may multiply. Being sexually active may also increase the likelihood of contracting a UTI.

As people progress through perimenopause, and estrogen levels continue to reduce, the muscles in the bladder and pelvic floor can weaken. This can lead to urinary incontinence, which is the uncontrolled leakage of urine from the bladder. Research suggests that this affects more than 50% of postmenopausal females.

The UCF states that 20–40% of females who experience a UTI will get another one. The authors of a 2019 study note that if a person has two infections during a 6-month period or three infections within a year, they have recurrent UTIs.

The chance of recurrent UTIs increases as a person progresses through menopause. The study authors report that 19–36% of premenopausal females experience recurrent UTIs. However, the rate of recurrence increases to 55% after menopause.

A 2019 article states that the decreasing levels of estrogen during perimenopause can lead to changes in the lining of the bladder, which can result in a change in the urogenital microbiome. This change in the microbiome reduces the natural defense mechanisms against UTIs.

Lactobacillus, a type of bacteria, colonizes a healthy vagina before menopause. The vaginal walls release a type of glucose called glycogen. Lactobacilli ferment the glycogen, producing lactic acid. This helps stop other types of bacteria from inhabiting the area.

In other words, the presence of Lactobacilli creates a microbiome in the vagina that can protect against other types of bacteria and pathogens.

The authors note that reduced levels of estrogen during menopause lead to lower levels of Lactobacilli and an elevated pH. This combination creates an environment that is more vulnerable to infection.

Other risk factors include:

  • diabetes
  • a history of UTIs
  • sexual intercourse
  • urinary incontinence

People with UTIs may feel a frequent, almost constant, need to urinate. A person may experience:

  • pain when passing urine
  • a burning sensation when passing urine
  • urine that is strong smelling and cloudy

In postmenopausal females, the preferred treatment is oral antibiotics.

Doctors usually ask for a urine sample, and they may recommend a urine culture to determine the type of bacteria causing the infection. This can help them decide which antibiotics to prescribe.

However, there is growing concern about bacteria becoming resistant to antibiotics. Healthcare professionals stress the importance of taking the full course of antibiotics, even if the symptoms have disappeared, to help prevent this.

Staying hydrated by drinking lots of water can help ease the symptoms of a UTI and speed recovery. Urinating frequently also helps flush the harmful bacteria out of the system.

People can also take nonsteroidal anti-inflammatory drugs (NSAIDs) and apply a heating pad to their back or abdomen to relieve pain and discomfort.

A person may not be able to prevent all UTIs, but some simple steps can reduce the risk of infections. These include:

  • staying hydrated
  • urinating before and after sexual activity
  • wiping from front to back during bathroom visits
  • replacing baths with showers
  • reducing the use of sprays or powders around the genitals
  • avoiding douching

Below, we provide answers to some frequently asked questions regarding menopause and urinary symptoms.

Can menopause cause frequent urination without infection?

During menopause, many people find that they need to urinate more often. Up to 77% of people wake up one or more times a night to urinate during menopause, according to an article in The Journal of the North American Menopause Society.

The article also suggests that lower estrogen levels may inhibit antidiuretic hormone, which helps regulate the amount of water in the body.

What are the other urinary symptoms of menopause?

The Office on Women’s Health states that throughout menopause, the lining of the urethra becomes thinner. This can lead to urinary incontinence.

The North American Menopause Society explains that there are two main types of urinary incontinence. These are:

  • Stress incontinence: This is when the bladder leaks when a person laughs or sneezes. It often starts during perimenopause but does not usually get any worse as the person progresses through the transition.
  • Urge incontinence: This is a sudden and urgent need to urinate, also known as overactive bladder. The muscles may not be able to stop the flow of urine completely, causing leakage.

Treatments are available, and various exercises designed to strengthen the pelvic floor — for example, Kegel exercises — can help. Doctors may also prescribe medications or surgical treatments.

Sometimes, home remedies and increased water consumption can flush bacteria out of the bladder before an infection takes hold.

However, the National Institute of Diabetes and Digestive and Kidney Diseases says that anyone experiencing nausea or vomiting, fever, or severe pain in the back alongside bladder-related symptoms should seek medical advice. This combination of symptoms can be a sign of a kidney infection.

The UCF adds that anyone with blood in their urine should see a doctor as soon as possible. Although this can be a sign of a UTI, it is also a marker for other urinary tract problems.

Many people experience UTIs during menopause due to the decreasing levels of estrogen, which can alter the microbiome in the vagina and bladder. The changes in the microbiome can make a person more vulnerable to UTIs.

Healthcare professionals will prescribe antibiotics to help treat UTIs. In the meantime, a person can relieve the symptoms by drinking plenty of water, taking NSAIDs, and applying a heating pad to the abdomen or back.