The hidden curse of recurrent UTI and Menopause
Recurrent urine infection in menopause
Why cystitis becomes more common and what actually helps
Recurrent urinary tract infections (UTIs), also known as cystitis, are a common and distressing problem for many women. For some, they become significantly more frequent during perimenopause and menopause, often leading to repeated courses of antibiotics and ongoing frustration.
So why does this happen, and more importantly, what is the most effective long-term solution?
The link between menopause and UTIs
The key factor is declining oestrogen levels.
Oestrogen plays an important role in maintaining the health of the tissues of the vulva, vagina and lower urinary tract. As oestrogen levels fall during perimenopause and menopause, these tissues become thinner, drier and more fragile. This process is known as genitourinary syndrome of menopause (GSM), previously referred to as vaginal atrophy.
The urethra, the tube that carries urine out of the bladder, is also oestrogen-dependent. When oestrogen levels are low:
The lining of the urethra becomes thinner
The natural protective barrier against bacteria is reduced
Changes occur in the vaginal microbiome, with fewer protective lactobacilli
Harmful bacteria can more easily colonise the area and enter the bladder
This combination significantly increases the risk of UTIs.
Why antibiotics alone are not the answer
Antibiotics are effective at treating an acute infection, but they do not address the underlying cause of recurrent UTIs in menopause.
If low oestrogen levels in the vulval, vaginal and urethral tissues are not treated, infections are likely to keep returning, regardless of how many antibiotic courses are taken. Repeated antibiotic use can also lead to:
Antibiotic resistance
Disruption of the gut and vaginal microbiome
Increased risk of side effects
This is why the British Menopause Society emphasises the importance of addressing oestrogen deficiency in menopausal women with recurrent UTIs.
Vaginal oestrogen: the evidence-based solution
The most effective long-term treatment for menopause-related recurrent UTIs is low-dose vaginal oestrogen.
Vaginal oestrogen works locally to:
Restore thickness and elasticity of vaginal and urethral tissues
Improve natural lubrication
Rebuild the protective vaginal microbiome
Reduce the risk of bacteria entering the bladder
Multiple studies and national guidelines confirm that vaginal oestrogen significantly reduces the frequency of recurrent UTIs in postmenopausal women.
Is vaginal oestrogen safe?
This is a very common concern.
Low-dose vaginal oestrogens are not the same as systemic HRT. They deliver a tiny amount of oestrogen directly to the tissues where it is needed, with minimal absorption into the bloodstream.
According to the British Menopause Society and Patient.info:
Vaginal oestrogens are safe for long-term use
They do not increase breast cancer risk
They can be used even by women who choose not to take systemic HRT
They are suitable for most women, including many with medical conditions that may limit systemic HRT use
Some women who are already taking systemic HRT still require additional vaginal oestrogen, so it is important not to assume that standard HRT alone will prevent GSM or UTIs.
What forms are available?
Vaginal oestrogen is available in several forms, including:
Vaginal pessaries or tablets
Vaginal creams
Your GP or menopause specialist can help determine the most appropriate option for you and guide you on correct use and duration.
When to seek specialist advice
If you are experiencing:
Recurrent UTIs or cystitis
Burning, stinging or soreness
Vaginal dryness or discomfort
Pain during sex
Urinary urgency or frequency
and you are in perimenopause or menopause, it is important to consider GSM as a possible underlying cause rather than repeatedly treating infections alone.
A personalised approach matters
Managing menopause-related symptoms is rarely one-size-fits-all. An individualised assessment allows treatment to be tailored to your symptoms, preferences and medical history, ensuring you receive evidence-based care without unnecessary antibiotics or investigations.
Final thoughts
Recurrent UTIs in menopause are common, but they are not something you have to put up with. Understanding the role of oestrogen deficiency and using effective treatments such as vaginal oestrogen can be life-changing for many women.
If you are fed up with recurrent cystitis or UTIs, speak to your GP or a menopause specialist about whether vaginal oestrogen could help.
If you would like expert, personalised menopause care in Manchester, Stockport or Cheshire, you can book a private consultation with me to discuss your symptoms and treatment options in detail.