Menopause occurs when your ovaries significantly decrease estrogen and progesterone production. You're not officially diagnosed with menopause until you've gone 12 months without a period, and your estrogen levels fall at or below 30 picograms per milliliter (pg/mL), according to the University of Rochester Medical Center. However, perimenopause refers to the years that your body transitions toward menopause. It includes symptoms like hot flashes, emotional changes, sleep disturbance, vaginal dryness, lower energy, slowed metabolism, the Mayo Clinic says.
- Lucky Sekhon, MD, board-certified OB/GYN, reproductive endocrinologist, and infertility specialist
A more surprising feature of menopause? You could also be more prone to urinary tract infections (UTIs). You might be aware that sexual activity is the most common risk factor for UTI, but hormone-related disturbances and bladder weaknesses are more common causes of UTIs during menopause. Below, a few experts break down why you might be dealing with UTIs more frequently and how to prevent them.
What causes a higher risk of UTIs during menopause
Menopause occurs for many people with vaginas and uteruses in their late 40s or 50s, but one can undergo "the change" any time if estrogen production is halted. This includes individuals who have their ovaries removed due to illness or gender confirmation surgery, and people who begin hormone replacement therapy on testosterone. Decreased estrogen impacts your vulva and vagina in ways that increase the risk of UTIs.
Typically, your vagina is usually quite acidic that helps fight harmful bacteria. However, when you transition through menopause and your body makes less estrogen, your vaginal pH lowers. The pH level of the vagina refers to how acidic the environment is, which is typically a four on the pH scale. However, a pH level of around seven is a strong indicator of menopause, according to the Journal of Midlife Health. Less acidity encourages less protective and more pathogenic bacteria to grow, Sharon D. Malone, MD, FACOG, NCMP, and medical director of Alloy Health says.
Essentially, estrogen helps promote an environment in your vulva that protects the urethra from infections. How does it do this? Well, estrogen promotes glycogen (the storage form of glucose) production within healthy vaginal lining cells, Felice Gersh, MD, a gynecologist and founder/director of the Integrative Medical Group of Irvine and the author of Menopause: 50 Things You Need to Know says. The good bacteria feed on the glycogen and release lactic acid—which acidifies the vagina, promoting the maintenance of optimal pH. This further encourages the establishment of friendly bacteria and thwarts the growth of rectal bacteria.
Waning estrogen levels also impact lubrication, which can put you at significant risk for pesky UTIs. With less lubrication, the tissue of the vagina dries and thins over time. This makes it susceptible to small, often unnoticeable, trauma either during intercourse or even with normal friction, Dr. Malone explains. These micro-tears or abrasions allow bacteria to penetrate the bladder and cause infections. The most common signs of this reduction in natural lubrication include general discomfort in the vagina, painful and dry sex, urinary frequency, and an itchy, dry vulva, says Dr. Malone.
Finally, you're more at risk for UTIs during menopause because estrogen aids bladder strength. When you go through menopause, especially if you are older, your bladder and pelvic floor muscles can weaken, impacting how effectively you are peeing, says Lucky Sekhon, MD, a reproductive endocrinologist at Reproductive Medicine Associates of New York. When you don't empty your bladder completely, any residual pee can put you at risk of a UTI as well.
Prevention techniques to try
First things first, if you suspect you have a UTI, all of these experts recommend contacting your doctor. UTIs don't heal independently, so you want to make sure that you don't have an infection that could get serious if left untreated.
The most common ways to protect yourself from UTIs during menopause are pretty similar to the tried-and-true UTI prevention methods. This includes peeing after sexual activity, staying well hydrated, frequently emptying the bladder, wiping from front to back, wearing clean underwear, and cleansing the area with water when you shower.
Additionally, since menopause significantly reduces the estrogen in your body, Dr. Malone says you can talk to your doctor about topical estrogen products or Dehydroepiandrosterone (DHEA) suppositories. Dehydroepiandrosterone is a hormone that promotes the production of estrogen and testosterone, according to the Mayo Clinic. So using it or estrogen products might encourage vaginal lubrication and preserve good bacteria in the vulva (which can help alleviate UTI culprits). It's also worth mentioning that topical and localized treatments are more effective than other hormone therapies because they're applied directly to the zone you are trying to treat, Dr. Gersh says. Still, you should talk to your doctor to troubleshoot any UTI symptoms and discuss potential medications for prevention.
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