Menopause can increase the risk of urinary symptoms, including a UTI after menopause, bladder urgency and urine leakage. Falling oestrogen can lead to changes in the vaginal and urinary tissues that make recurrent UTIs, sometimes called recurrent cystitis, more likely.
Hot flushes, sleep problems and mood changes are widely recognised menopause symptoms. However, changes affecting the bladder, urethra and pelvic floor are often overlooked. These symptoms can affect confidence, work, sleep, relationships and day-to-day comfort.
Urinary symptoms are not something you should simply put up with. Understanding the link between menopause and urological health can help you seek the right support.
Understanding the link between menopause and urological health
Menopause happens when periods stop because the ovaries produce much less oestrogen. Oestrogen supports tissues throughout the body, including the vagina, bladder outlet and urethra, which is the tube that carries urine from the bladder out of the body.
As oestrogen levels fall, these tissues can become thinner, drier and less elastic. The pelvic floor muscles may also become weaker over time. Together, these changes can affect bladder control and make urinary infections more likely.
Many of these symptoms are part of genitourinary syndrome of menopause, often shortened to GSM. GSM is the medical term for menopause-related changes affecting the vagina, vulva, bladder and urinary tract. Vaginal atrophy is an older term that describes thinning and dryness of the vaginal tissues.
How decreased oestrogen affects the urinary system
Oestrogen helps maintain healthy vaginal and urinary tissues. It also supports the natural balance of bacteria in the vagina, sometimes called the vaginal microbiome.
After menopause, the vaginal environment becomes less acidic and there may be fewer protective bacteria. This can make it easier for bacteria that cause urinary tract infections to grow and reach the urethra and bladder.
Lower oestrogen may also contribute to:
- Vaginal dryness, soreness or irritation
- Discomfort during sex
- A burning sensation when passing urine
- Needing to pass urine more often
- Sudden urgency to pass urine
- Bladder leakage
- Repeated episodes of cystitis or UTIs
Not all urinary symptoms are caused by infection. GSM, overactive bladder and other bladder conditions can cause symptoms similar to a UTI. If symptoms keep returning, it is important to establish whether there is an infection rather than repeatedly treating symptoms without a review.
Common urological problems during and after menopause
Urinary incontinence
Urinary incontinence means leaking urine when you do not intend to. Stress urinary incontinence can happen when coughing, laughing, exercising or lifting. Urge urinary incontinence happens when there is a sudden, difficult-to-control need to pass urine.
Some women experience mixed incontinence, which includes both stress and urge symptoms. Changes in pelvic floor strength, bladder function and urethral tissues can all play a part.
Pelvic floor exercises can help strengthen the muscles that support the bladder and bowel. They are often most effective when taught by a pelvic health physiotherapist. Some women may also wish to discuss the EMSELLA chair for pelvic floor rehabilitation as part of a wider treatment plan.
Find further information about menopause and incontinence: treatments to reclaim your confidence.
Recurrent UTIs after menopause
Can menopause cause UTIs? Menopause does not directly cause an infection, but it can make UTIs more likely. Lower oestrogen can lead to GSM and vaginal atrophy, which affect the pH and microbiome of the vagina. These changes reduce some of the body’s natural protection against infection.
This helps explain why some women experience a UTI after menopause more often than they did previously. UTIs are also more likely to recur in older women, although other factors may be involved, such as incomplete bladder emptying, a prolapse, kidney stones or certain medical conditions.
A recurrent UTI is usually defined as:
- Two or more confirmed UTIs within six months
- Three or more confirmed UTIs within 12 months
Repeated UTI symptoms can be frustrating and disruptive. However, symptoms should be assessed carefully, particularly if urine tests have been negative or antibiotics have not helped. This can help distinguish a bacterial infection from GSM, overactive bladder or another bladder condition.
For general information about symptoms, causes and diagnosis, read urinary tract infections: symptoms and causes.
Overactive bladder
Overactive bladder causes a sudden urge to pass urine that can be difficult to delay. It may lead to frequent trips to the toilet, waking at night to urinate or urge leakage before reaching the toilet.
Menopause-related changes to the bladder and urethra can contribute to overactive bladder symptoms. As urgency and frequency can also occur with a UTI, an assessment can help identify the most likely cause.
What can help menopausal urinary symptoms?
The most suitable treatment depends on your symptoms, whether infection has been confirmed and your medical history.
For women with recurrent UTIs after menopause, vaginal or topical oestrogen is an important first-line treatment option when simple behavioural and personal hygiene measures have not helped or are not appropriate. It can improve menopause-related changes in the vaginal and urinary tissues, including dryness and irritation, while helping to reduce the risk of further UTIs.
Vaginal oestrogen is applied locally as a cream, gel, tablet, pessary or ring. It is different from systemic hormone replacement therapy (HRT) which circulates throughout the body. Systemic HRT is not prescribed specifically to prevent recurrent UTIs.
A clinician can discuss whether vaginal oestrogen is suitable for you, particularly if you have a personal history of breast cancer or are having treatment for breast cancer. NICE recommends considering vaginal oestrogen for recurrent UTIs in people who are perimenopausal or menopausal when appropriate.
Other support may include:
- Pelvic floor muscle training for leakage and bladder support
- Bladder training for urgency and overactive bladder
- Staying well hydrated
- Reducing caffeine or alcohol if these worsen bladder symptoms
- Avoiding perfumed soaps or products that irritate the genital area
- Antibiotics for confirmed infections when clinically appropriate
- Further investigation where infections are recurring or symptoms persist
Repeated antibiotic treatment is not always the answer. It may not address GSM or another underlying bladder problem, and long-term antibiotic use can have side effects and contribute to antibiotic resistance.
When to seek medical advice
Arrange a medical review if you have recurring cystitis symptoms, frequent UTIs, persistent urinary urgency, urine leakage or vaginal discomfort that is affecting your quality of life.
It is particularly important to seek advice if you:
- Have had two UTIs in six months or three in 12 months
- Continue to have symptoms despite treatment
- Have UTI symptoms but urine tests do not confirm an infection
- Notice blood in your urine
- Have pain in your side or back
- Have a fever, chills, vomiting or feel generally unwell
Seek urgent medical help through NHS 111, or attend A&E if symptoms are severe, you feel confused, you are unable to keep fluids down or you become seriously unwell.
A consultant urologist can assess recurrent UTIs, bladder symptoms and incontinence in the context of menopause. A private GP appointment may also be a helpful first step for new or non-urgent symptoms.
Getting the right support
Bladder symptoms, urine leakage and recurrent UTIs can be common during and after menopause, but they should not be dismissed as an unavoidable part of ageing.
A careful assessment can help clarify whether symptoms are related to infection, GSM, vaginal atrophy, pelvic floor changes or an overactive bladder. The right support can then be tailored to your needs and preferences.
The Forbury Clinic provides consultant-led urology care for women with recurrent UTIs, bladder symptoms and urinary incontinence. To discuss your symptoms and appropriate next steps, contact our team to arrange an appointment.
