Why Older Women Are Suffering from UTIs
Hello, Bestie and thanks for hanging out with me today. Today’s topic brings together urinary tract infections (UTIs), menopause, hormone replacement therapy (HRT), and a book I read earlier this year. These may all seem like unrelated topics, but I promise by the end of this chat, you’ll see that they are nicely interwoven. Whether you are postmenopausal yourself or still at the very start of your childbearing years, this post is for you, Bestie. In the transition from pre- to post-menopause, the body changes and these changes are rarely discussed in depth. I want to start the conversation here, and I promise to return to this topic frequently since it is such an important one.
Earlier this month (December 2023), The Observer (owned by The Guardian) published an article titled “Millions of women are suffering who don’t have to: why it’s time to end the misery of UTIs” (1). In this article, the authors talk about how UTIs are plaguing postmenopausal women and why this is the case.
As you might recall, a UTI is an infection that can affect the urinary tract and most commonly affects the bladder. This causes symptoms such as mild fever, dysuria (painful urination), bladder pain, urinary urgency, cloudy urine, and more. UTIs can occur in any population, but most often affect females. This comes down to anatomy: in females, the urethra is shorter and there is less distance for bacteria to travel in order to infect the bladder. Males have longer urethras and therefore there is a higher barrier to entry for bacteria. However, even amongst females, there is discrepancy in those who are most commonly afflicted with UTIs.
Perimenopausal and postmenopausal people are the most common group of folks to experience UTIs (note that this includes women, some nonbinary folks, and transgender men). Prior to menopause, vaginal tissue is kept supple with the hormone estrogen. When menopause occurs, estrogen is depleted leaving the tissue drier, thinner, and less plump. Not only this, but the natural microbiome of the vagina is changed. This can result in the tissue being more susceptible to harmful bacteria and leads to increased occurrence of UTIs.
While this entire experience is well understood, it feels like its treatment is stuck in the Dark Ages. UTIs are often treated in postmenopausal females the same way they are treated in young 20-somethings: an antibiotic is prescribed and one must finish out the dose to ensure all of the bad bacteria are extinguished. This strategy can be effective for people who only experience UTIs infrequently—but menopausal people are far more likely to deal with them, and so are prescribed antibiotics over and over. I’ve even had patients tell me they were going to their doctor for UTI antibiotics so often that they were given antibiotics to take prior to engaging in vaginal penetrative intercourse since every time they did, they would end up with a UTI.
However, there is a key difference between UTIs in pre-and post-menopausal women and treatments should reflect this difference. Oh yes, we’re talking about the presence of estrogen. Topical estrogen applied to the vaginal tissues can help to plump up the tissues and reduce frequency of UTIs. It can also help decrease urinary leakage (incontinence), decrease vaginal dryness, increase comfort during vaginal penetrative intercourse, and reduce fragility of the vaginal tissue. It can even reduce antibiotic-resistance in bacteria since fewer UTIs mean fewer rounds of antibiotics.
So, why is it that postmenopausal folks are treated first with antibiotics and not with estrogen? If estrogen is protecting younger females from UTIs, why wouldn’t this be the first line of treatment? These are the questions so many healthcare professionals are asking.
The answers to these questions are multifaceted and complex, but one reason likely goes back to a study that was done by the Women’s Health Initiative (WHI) years ago that falsely stated the dangers of hormone replacement therapy (HRT). Even though the results of this study have been shown to have been exaggerated and misleading, it has left a lasting fear of estrogen/hormone replacement in the world of healthcare. In reality, the use of HRT is safe for most folks and topical vaginal estrogen has been shown to be safe, even in individuals with a history of breast cancer (3).
Let’s finally circle back to the book I mentioned at the start of our chat. Earlier this year, I read “Menopausing” by Davina McCall. Davina is a television personality-turned-advocate-for-women. I wish I knew her, because she would definitely be a Bestie. In her book, she discusses her experience with perimenopause and menopause, as well as that with HRT. As Davina outlines, menopause is way harder than it looks. Women deserve to have medical support from their doctors, but are instead forced to do their own research and plead with their healthcare professionals until they get relief. UTIs are just one example of this: a female issue that is not always treated with the weight it deserves.
UTIs are, at best, a miserable few days and at worst, fatal. If you are postmenopausal and struggling with frequent UTIs, talk with your medical provider about HRT or topical vaginal estrogen. Remember that this is not a blanket solution, but a personal decision that should be made between you and your healthcare professional. If you want more information on this topic or just want to feel less alone, I hugely recommend “Menopausing” by Davina McCall. Even if you feel you are nowhere near menopause, I still recommend the book, as if gives perspective about those in your life who may be going through menopause, as well as tips for advocating for yourself in a healthcare setting.
XOXO,
Your Pelvic Bestie
References:
Muir, K. (2023, December 17). ‘Millions of women are suffering who don’t have to’: why it’s time to end the misery of UTIs. The Guardian. https://www.theguardian.com/society/2023/dec/17/millions-of-women-are-suffering-who-dont-have-to-why-its-time-to-end-the-misery-of-utis
Czajkowski K, Broś-Konopielko M, Teliga-Czajkowska J. Urinary tract infection in women. Prz Menopauzalny. 2021 Apr;20(1):40-47. doi: 10.5114/pm.2021.105382. Epub 2021 Apr 21. PMID: 33935619; PMCID: PMC8077804.
Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer. (n.d.). ACOG. https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/12/treatment-of-urogenital-symptoms-in-individuals-with-a-history-of-estrogen-dependent-breast-cancer
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
