Estrogen, Menopause and Bladder Infections

Bladder Anatomy
Menopause Increases Bladder Infections. Mache Seibel

Women's reproductive tracts and urinary tracts are very sensitive to estrogen. So as a woman transitions from her reproductive years into menopause and beyond, less estrogen is available to those tissues, and that causes major changes. When estrogen is abundant during the reproductive years, the end of the urethra, the tiny tube that carries urine out of the bladder, typically ends flush with the tissues of the upper vagina.

It's protected. As menopause approaches and estrogen levels become lower, the upper vagina tissues shorten and narrow and pull back from the tip of the urethra. That leaves the tip of the urethra exposed to more bacteria and more at risk for infection. This is a major difference in the risk of UTI's between menopausal and non-menopausal women.

Here are three more benefits of estrogen on the urinary tract:

  1. It encourages the bladder to produce natural antimicrobial substances
  2. It strengthens urinary tract tissue by closing the gaps between the lining cells of the bladder. Keeping these gaps together makes it harder for bacteria to invade the deeper layers of the bladder wall
  3. Because estrogen helps prevent shedding of the bladder's lining cells, they form a greater barrier to infection when bacteria enter the bladder

Here are my top 5 ways to lower your risk of UTI's during The Change:

  1. Control or correct other medical conditions. Women with diabetes or who have a sensitive bladder issue such as a problem emptying their bladder are at increased risk. So controlling blood sugar if you have diabetes, correcting bladder problems and emptying your bladder before and after intercourse help lower the risk of UTI's.
  1. Chronic antibiotics. Staying on chronic antibiotics such as nitrofurantoin can be effective but can also lead to bacterial resistance, so this approach is becoming less popular.
  2. Cranberry extract. By making the urine more acidic it lowers the risk of UTI's. It is somewhat helpful but study results are mixed. It can't hurt but may not help.
  1. Probiotics. Instead of trying to kill "bad bacteria," some studies investigate putting "good bacteria" into the pelvic organs to recreate balance. Taking oral lactobacillus twice daily is helpful. You can take them by mouth and the higher the concentration of lactobacillus, the better. Compare labels and get the one with the most "good" bacteria in them.
  2. Estrogen. At the beginning of our discussion, I talked about UTI's and how low estrogen levels cause changes in the female pelvic tissues. It makes sense that low dose estrogen - if your doctor feels it is safe for you and it is something you are comfortable taking – is a very effective way to prevent recurring UTI's by restoring those tissue changes. Local estrogen in the form of a tablet, cream or vaginal ring all work. When estrogen is applied locally (directly to the reproductive or outer vaginal tissues) it mostly stays in the vaginal area.  Some forms do get into the blood stream so discuss this with your doctor. A one-year study compared using local estrogen with taking chronic antibiotics in more than 250 women. Both groups of women went from having an average of seven UTI's per year to roughly half that many. The women who took local estrogen also benefited by improving their vaginal dryness and painful sex without contributing to antibiotic resistance. That's why estrogen is my first line choice in preventing UTI's in menopause.

    If you are going through The Change and experiencing UTI's, talk with your doctor about what approach is best for you. I've seen many of my older patients develop UTI's that become a silent cause of sepsis or total body infection. Since over half of women will have a UTI and about 25-30% of those under 55 and over half of those ≥ 55 will get another UTI within 6-12 months, prevention is key!

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