Nurse Maureen‘s Health Show

Recurrent UTIs in Menopause: Prevention Strategies That Work

• Maureen McGrath

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Speaker 1:

Good evening and welcome back to Nurse Maureen's Health Show Podcast. Thanks so much for tuning in. Tonight we're diving into an important and often overlooked topic urinary tract infections in menopausal and postmenopausal women. I should say recurrent urinary tract infections in menopausal and postmenopausal women because that can happen time and time again, but it's important to know that there are prevention strategies and treatments available. If you're in midlife or beyond and you've noticed that you're getting more frequent urinary tract infections even two in six months or three in a year you are not alone. It's a common issue that many women don't talk about, but one that has real impact on quality of life, intimacy and even long-term health. So let's explore why this happens, what to look out for and, most importantly, what you can do about it. First of all, I'd like to start with why urinary tract infections, or UTIs, increase at menopause, and the short answer is estrogen. As your estrogen levels drop during perimenopause and menopause, several changes happen in the urogenital tract. The tissues of the vagina and urethra can become thinner, less elastic and more fragile. There's a natural acidity of the vagina and this also decreases as well, so all of that makes it easier for bacteria like E coli to thrive, plus, the loss of protective vaginal bacteria, specifically lactobacilli, alters the microbiome and without them, the environment in the urogenital tract becomes more vulnerable to infection. There's also the issue of bladder function. As women age, we may not empty our bladders completely, which also allows bacteria to grow, and in things like pelvic floor weakness, prolapse or even stress, urinary incontinence, the risk just keeps climbing, especially with prolapse. For example, if you have prolapse, such as anterior wall prolapse, you may actually not empty, not be able to empty your bladder effectively, and in fact, you might notice that you have to change position in order to empty it. Your stream might become slower, but the urine that stays back in the bladder can actually be prone to urinary tract infection.

Speaker 1:

Now let's talk about how a urinary tract infection can actually show up. What are the classic symptoms? Well, they include burning or stinging when you urinate. You can also get urgency and that feels like you constantly have to go. You might void in small amounts, you might have cloudy or foul smelling urine, and you may also have lower pelvic pressure or discomfort abdominal pain.

Speaker 1:

But here's something especially important for older women or those caring for aging parents or partners Urinary tract infections don't always present in typical ways. You can get some atypical symptoms like diarrhea, fatigue, chills and even confusion or sudden changes in mental status. They can all be signs of a urinary tract infection, especially in the elderly. So if something feels off, trust your gut and get it checked out, because urinary tract infections can be very dangerous in older women, because you can get urosepsis and even and I hate to say this you can even die early from a urinary tract infection. I can't tell you how many patients of mine tell me that their mothers died of a urinary tract infection. I can't tell you how many patients of mine tell me that their mothers died of a urinary tract infection. They're like can you believe it?

Speaker 1:

Because before menopause, we think of urinary tract infections in younger women as something that happens fairly frequently. It happens after sex Not to say that older women aren't sexually active and it is important to empty your bladder after sex. But you don't have the risk of urosepsis when you're younger and getting UTIs. So people often think of UTIs as not a big deal. But in menopause and beyond, utis can be a big deal. But there is good news Urinary tract infections or UTIs are treatable and often preventable and one of the most effective options for postmenopausal and menopausal women is vaginal estrogen therapy.

Speaker 1:

In fact, according to research, it can prevent urinary tract infections 65% of the time. Unlike hormone replacement therapy, it's localized treatment. It works directly in the vagina and the urethral tissues and it improves tissue strength, ph balance and restores beneficial bacteria. But I do want to mention that the treatment and recently I saw on social media one of the influencer doctors she mistakenly said that the treatment for urinary tract infections is estrogen. Remember that is prevention. The treatment for urinary tract infections is estrogen. Remember that is prevention.

Speaker 1:

The treatment for urinary tract infections are antibiotics. They are commonly used for active infections and for those with recurrent urinary tract infections. Sometimes a low-dose antibiotic protocol is considered, but always under the guidance of your healthcare professional. There are also some non-prescription options that might help to prevent you from getting a urinary tract infection. D-mannose is one of them. It's a natural sugar that helps prevent bacteria from sticking to the bladder wall. Cranberry supplements may help for some, but the evidence is limited and it varies, to be honest with you. And, of course, hydration drinking water, dilute urine, is much healthier for the bladder, less irritating to the bladder than concentrated urine, and hydration helps you to keep your urine, dilute, front to back wiping, avoiding after sex and avoiding harsh soaps or douches. Your vagina is like a self-clean oven and you don't need to use any soaps or anything or douches to clean it, so your vagina will take care of itself.

Speaker 1:

But there are some other factors to consider as well. It's not just about bacteria. We also need to consider pelvic floor weakness, vaginal dryness or some of the other symptoms of genitourinary syndrome of menopause burning, itching, frequency, nocturia, urinary incontinence, chronic illness like diabetes can also increase your risk of urinary tract infection, and also catheter use or certain hygiene practices. All of these can contribute to recurrent urinary tract infections. If you are menopausal, post-menopausal and you've gotten two urinary tract infections in a six-month period, it's time to see your doctor about getting treatment with localized estrogen therapy to prevent you from getting urinary tract infections, because you can get very sick. You can be hospitalized and you can. In fact, it's one of the most common causes of emergency room visits in older women. They sometimes present as only confusion, lethargy or diarrhea. So it's really important that you keep track of when you've had a urinary tract infection. If you have three in the past year, you definitely need to have preventive prevention strategy like low-dose localized estrogen therapy and then some of the other prevention strategies I mentioned, like voiding after sex and front front to back wiping and making sure that you drink enough water.

Speaker 1:

But urinary tract infections aren't just uncomfortable. They can disrupt sleep because you can be getting up at night to void intimacy, work and independence. And in older women, as I mentioned, they are one of the most common, if not the most common, reasons that you would go to the emergency department. And so if you have there's an older woman in your life and they are confused, lethargic, they're having diarrhea, you know what you might think urinary tract infection. But you don't have to suffer in silence. As I mentioned, there are effective solutions and you deserve to feel comfortable and confident in your body. So it's very important that you pay attention to what may, in your whole life, have seemed to have been problems, just a nothing issue that is annoying and can impact your quality of life a urinary tract infection. But they're very different at menopause and after menopause.

Speaker 1:

And something else I wanted to mention is that it is never too late to use localized estrogen therapy and it comes in the form of a cream, a tablet or a ring. It's never too late to start using that. In fact, women are too late to start using it. A lot of the damage has been done because the vaginal tissues can change. They may have experienced urinary incontinence, urgency, urinary tract infection. So estrogen is excellent and it's low dose. It does actually cross over systemically but there is not an increase or an associated increase risk of breast cancer. But some does cross over into the systemic area and you may actually feel some breast tenderness. Some women report abdominal pain. If you take too much of it you might get a yeast infection.

Speaker 1:

But it's a very important hormone that can prevent urinary tract infections. And so I had one doctor one time say you know, she's 83, she's too far from menopause. It's not going to help her for me to prescribe low dose localized estrogen therapy, but that's infections. And so I had one doctor one time say you know, she's 83, she's too far from menopause. It's not going to help her for me to prescribe low dose localized estrogen therapy, but that's not the case. It is for postmenopausal women. It's just important. It's an important subject and I'm happy to educate you about this. I talked to my colleagues about this. I educate a lot of colleagues about it because you know women will come in presenting with symptoms and you know you may not associate it with urinary tract infection or you may not realize that these women, once the estrogen decreases in the urogenital tract and they can get dryness and pain with sex, burning, itching, and also they're at increased risk of urinary tract infection. So very important to address this issue and improve the quality of life for yourself and or, if you're a healthcare provider, your patients. If you think that this episode will help somebody else, feel free to share it. Anyway, I am Maureen McGrath, the registered nurse, nurse, continence advisor, sexual health educator, and thank you so much for tuning in.

Speaker 1:

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