Urinary tract infections in women with Professor Chris Harding

Professor Chris Harding is a Consultant Urologist working at the Freeman Hospital in Newcastle upon Tyne and at Newcastle University. He has a particular interest in bladder dysfunction, continence and urinary tract infections (UTIs). In recent years, his research has focused on non-antibiotic treatments for recurrent UTIs and developing targeted treatments for specific patient groups.

In this episode, Professor Chris talks to Dr Louise about the challenges of diagnosing UTIs accurately, the severe impact recurrent UTIs can have on your life, how antibiotics can be used appropriately, and how to prevent UTIs occurring. The experts share some of their plans to study the effects of systemic HRT and vaginal hormone treatments on UTIs in women.

Chris’s advice if you have recurrent UTIs:

You don’t need to put up with UTIs in the perimenopause and menopause; there are many proven treatments available

Acknowledge that current tests for UTIs are not 100% accurate. If you think you have a UTI, you probably have, even if your test was negative – the diagnosis can always be questioned

Discuss with your doctor how you can prevent infections if you have had 2 episodes within 6 months, or 3 within a year

Hormone replacement, particularly vaginal treatments, are significantly protective and preventative against UTIs.

Follow Prof Chris Harding on social media at @chrisharding123

Episode transcript:

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:46] So today on the podcast, I’m very excited and delighted to introduce to you someone that I’ve been stalking for quite a long time without him realising actually. So someone called Professor Chris Harding, who I was first introduced to or about really, from my husband Paul who’s a urologist and he kept saying, ‘You need to read this guy’s work’. So I have been reading a lot of his work and kept saying to Paul, ‘I’m going to try and reach out to him’. And he said, ‘Don’t, you’re a menopause specialist. He’s not going to be interested in you, Louise’. But now here I have him in the studio. So thanks, Chris, for coming today.

Professor Chris Harding [00:01:21] It’s a pleasure to join you.

Dr Louise Newson [00:01:22] So you’re obviously a urologist like my husband, but you’re different to my husband because you specialise differently and you’re very academic and you have the most amazing past record of research as well. So do you mind telling me a bit about why you do what you do and how you got here?

Professor Chris Harding [00:01:39] So I’m a consultant urologist, as you say, and I work in Newcastle and for about a third of my working week I work in Newcastle University with an absolutely amazing team of very clever scientists who do most of the hard work for me. And our research programme is centred around urinary tract infection and looking at various different factors, the microbes themselves, the host response, and we’ve kind of over the last 5 to 7 years concentrated our efforts on non-antibiotic treatments for recurrent urinary tract infections. And we’re now really thinking about different patient groups and how we might target treatments, particularly some novel treatments because of course the issue with antibiotics is the emerging problem with antimicrobial resistance. So that’s in essence what we do, if anything is UTI related, I’m interested in it.

Dr Louise Newson [00:02:39] Brilliant. And how did you get into that? Why did you decide urology in the first place then Chris.

Professor Chris Harding [00:02:44] By accident, really, I did a job on the King’s College rotation in London and I was originally on a pathway to do neurosurgery, but I did a six month training scheme in neurosurgery, didn’t really fall in love with it and then did a urology job, which I absolutely adored. And I thought that urology sort of gave me the ability to do a little bit of academic work, a bit of operative surgery. And it was just the perfect balance, really.

Dr Louise Newson [00:03:12] And what about, there’s lots of areas of research in urology, isn’t there? So why did you decide to do urinary tract infections?

Professor Chris Harding [00:03:19] Well, I like a challenge. Urinary tract infections are a big problem. It affects a lot of people. And I think with regards to the impact you can have with research, urinary tract infection is such a massive area. It’s probably one of the few bits of urology that every single urologist gets involved with. And not just every single urologist, but every medical practitioner will probably as part of their usual work pattern, have to treat UTI. So if you do make any kind of significant contribution in that field, then the size of the impact is potentially massive.

Dr Louise Newson [00:03:56] Like the menopause really, isn’t it? It is huge and almost overwhelmingly huge. And we always talk about how common they are, especially in women. But are there many women that have never had a urinary tract infection, do you think?

Professor Chris Harding [00:04:09] Yeah, no, I do. I think if you look at the statistics, 50% of women will have a urinary tract infection, at least one episode in their lifetime. But that means 50% won’t. And of course, that leads you to thinking many different things. You know, is there some kind of genetic predisposition? And there are a few abnormalities that have been explored in previous research, but there’s nothing really too concrete. But I think the thing with urinary tract infections, it sounds, you know, fairly typical. Oh it’s an infection, you get antibiotics and you move on. But actually, when you talk to these women, in particular, the impact of UTI on their daily living, their quality of life is enormous and especially if they start to develop recurrent urinary tract infections that can almost govern their lives. And therefore, as I said before, the amount of impact you could potentially have with, you know, some research that might change clinical pathways is enormous.

Dr Louise Newson [00:05:06] And when you say recurrent urinary tract infections, can you just explain what that is Chris, do you mind?

Professor Chris Harding [00:05:12] Yeah. So I think we’ve been arguing for many years about what recurrent urinary tract infection actually means. But over the last few years we’ve settled on a standardised definition which is either two episodes in six months or three in a year. I think in reality sufferers of recurrent UTI will have many more episodes. A recent clinical trial that we’ve published, the average number of UTIs suffered per year by the trial participants was around seven. So, you know, you can imagine seven episodes of UTI in one year. It’s going to have a significant effect on your life. Every aspect of it.

Dr Louise Newson [00:05:48] Yeah, absolutely. And it’s, can be quite hard sometimes to diagnose urinary tract infections. So when I was in general practice, we’d have lots of women I’m thinking back, they were usually menopausal women actually, who would queue outside the surgery at 8:00 in the morning waiting for it to open with their urine pots that they’d filled because they were having horrendous symptoms, especially over the weekend and then the receptionist would usually dip them and if the dipstick was negative, they’d say, ‘Well, you haven’t got a urinary tract infection’. And there’d be others that would be sent off to the labs saying, ‘Well, we’ll get your result in three or four days’ time. We’ll contact you if it shows anything’. And looking back, I think well, was that good practice? Because these women were still suffering. So it was almost like they couldn’t have an appointment unless they had a proven urinary tract infection, but they were having symptoms. And there are some problems, aren’t there, with dipping the urine or doing an actual test where it goes off to their hospital laboratory?

Professor Chris Harding [00:06:42] Yeah. I mean, there are so many problems with UTI diagnostics, you know, this is one of the reasons why NICE have recently made this a priority and I’ve decided to set up a taskforce with regards to UTI diagnostics. I think the main thing is that I can remember when I was a medical student, the classical teaching was that the bladder was a sterile environment. Now of course we know with sophisticated techniques like PCR that can amplify even the smallest amount of DNA, the bladder actually has a bacterial environment and microbiome, as we call it, all of its own. And therefore, tests are requiring some kind of demonstration of the isolation of the bacteria. They may well be flawed because it may well be that you can regularly demonstrate bacteria in a patient’s urine. But whether or not that’s the causal bacteria for their symptoms is another question. Now, of course, on the other side of the spectrum, there are many, many women who undoubtedly have urinary tract infections. They have symptoms which suggest they have infection, they have a reliable response to antibiotics and yet their urine test will always, you know, come back negative as the phrase goes. And this may be just a function of the fact that most women, when they get UTI symptoms, do what we would all do, which is increase our fluid intake, dilute the urine, and that includes diluting the amount of bacteria that’s in the urine. I think we’ve got to really look at UTI diagnostics in the next 5 to 10 years and really try and come up with something that is a little bit more accurate, a bit more reliable, and maybe that doesn’t solely rely on the demonstration of a bacteria in the urine. And the tests we use now, you know, they’re decades and decades old, they’ve not really been refined enormously you know, in the last, I would say, 20 to 30 years. Now, the research we’ve just published didn’t rely on the demonstration of bacteria in urine and that’s why I think it was so novel. We called the UTI a UTI if the women had suggestive symptoms and if an independent healthcare practitioner assessed those symptoms and thought they were, you know, enough to merit a course of antibiotics targeted for uropathogenic bacteria, and I think research has now got to move towards that kind of clinical definition of urinary tract infection.

Dr Louise Newson [00:09:12] Mm hmm. Which is very interesting, isn’t it? Because I think I know I’ve done women a disservice in the past, because sometimes if the clinical diagnosis and the biochemical diagnosis or the microbiological diagnosis is different, in the past, I suppose especially as a more junior doctor, you look at the numbers or you look at the results and you try and sometimes fit the symptoms into the results. And then if you’ve got a result saying this woman, you know, doesn’t have a proven UTI from her results, then sometimes you can almost not believe the women who are sitting there saying, “But I’ve got these symptoms and it’s so horrendous”. And then I think that that can be really disparaging to – I’m talking women, obviously, because it’s more common in women, but even to men as well. And I think it’s really important and amazing that you’re moving the agenda and changing the way that we diagnose, because it is really important, because it’s very important to get the diagnosis right, of course it is. But it’s also very important to look at the right treatment options for these women, because it can cause, like you say, a lot of distress and a lot of other symptoms can occur as well. It’s not just that people need to wee a bit more often. People can be in pain and it can really ruin people’s lives having recurrent UTIs.

Professor Chris Harding [00:10:33] No, absolutely. I mean, there’s a couple of things to pick up on there. Firstly, is the severity of symptoms associated with these episodes. So, you know, you can have a patient who is usually fully continent have really, really debilitating urinary incontinence. You know, you can have a patient who sleeps through the night, usually getting up five, six, seven, ten times to void, pain whenever they pass water, generalised symptoms, you know, an infection in any body tissue can cause generalised symptoms. And that has sort of a knock-on effect. They don’t want to – they can’t go to work. They can’t do the jobs that they normally would do. You know, and obviously, relationships, they find intimacy with their partner’s impossible because everything is so sore. I think the second thing to pick up on there is the almost belief that we’ve got to break, which is that a negative urine culture means there’s no infection present. I really think that’s the single most important thing to pass on to other healthcare professionals. You know, I mean, I hear stories all the time. You may have a woman who’s had several episodes of urinary tract infection in a lifetime, all responded to antibiotics, presents with the exact same symptom set and yet this time the urine comes back negative and is denied antibiotic treatment. Now, a lot of the time, the urinary tract infection, you can clear with your own immune system, but a lot of the time you can’t. And yet denying these people treatment, I think, you know, you talk about doing patients a disservice. I think that’s a really good example of that. And I think the third thing to bring up is that in urology, there’s just a finite number of symptoms. So, you know, pain passing water, urinary frequency, peeing a bit of blood, you know, they could have so many different causes. You know, a urinary tract infection will be the most common, a bladder stone, a tumour in the bladder. All of those three very different diagnoses could contribute to that symptom complex. So, you know, I think we’ve just got to listen to the patients a little bit more. And, you know, I find if a woman tells me she’s got a urinary tract infection, 99% of the time, she’ll be right.

Dr Louise Newson [00:12:52] Yeah, I think that is so important. But I think it’s also looking at ways we can reduce urinary tract infections as well. And I think certainly when I was younger as a sort of more junior GP, I would – you treat the problem and then you wouldn’t think ahead. And certainly now, a lot of my time is thinking ahead to prevent a condition. But if someone has it, how can we reduce the risk of it happening again? And I think that’s really important and actually I have learnt quite a lot from my husband, believe it or not, even little things like some women who have urinary tract infections after having penetrative sex, just them emptying their bladder after having sex. And some people have a prophylactic antibiotic which can actually be better than having a course of antibiotics frequently if they are prone to it. But looking at some of their intimate hygiene as well, because there’s so many products now that are available over the counter that are sort of intimate washes and scented goodness only knows what. And some of those can cause a lot of irritation, can’t they, to the vulva, the vagina, the urethra. And so some women can get a lot of irritation. And then if they have a urine infection or just urinary symptoms, that might not be an infection, looking at any triggers that can cause this pain are really important actually to consider, aren’t they?

Professor Chris Harding [00:14:17] Yeah. I mean, I think UTI prevention is the key really for a number of reasons. You know, we’re living in a world where, you know, not to be overdramatic – we are running out of antibiotics. And at some stage we may be faced with a patient who you don’t have an antibiotic option for, and it will be over to the patient and their immune system to clear this infection or not. And that’s like a throwback to kind of pre-penicillin times. So it is really important to look at UTI prevention and you know, there’s good evidence for a range of different agents that you can use for UTI prevention. You know, there’s even a randomised controlled trial which looks at drinking more water, which is a real common sense thing to do. But you know, you can see several different reports and recommendations with regards to prevention. And as you say, you know, sometimes even using antibiotics as a preventative measure, for instance, the example you gave which was post-coitally, you know, that can actually result in your overall antibiotic consumption going down. If you’re avoiding infection, which may require a three-, five-, seven-day course of antibiotics, then taking a small dose of an antibiotic each time you have intercourse, your overall antibiotic consumption can be less. So I think it’s you know, it is vital to look at UTI prevention. You know, we talked about diagnostics a few moments ago, but actually, I think, you know, the prevention of urinary tract infections is really, really important. And, you know, you can actually prevent them with non-antibiotic agents, which is, that’s the best, isn’t it, because you don’t use any antibiotics at all. You save the antibiotics for the times when they get break-throughs. I think you know, it’s important that women realise when they’re on a preventative therapy that this is not going to be the end of all their UTI’s forever. They will get the occasional UTI and it’s important to realise that that is probably best treated with antibiotics. But you know, the other times when they’re not having UTI’s, prevention and reducing the frequency of these episodes is absolutely key.

Dr Louise Newson [00:16:26] Absolutely. And that’s one of the reasons, obviously, that I wanted to reach out to you many years ago. And I was forbidden by my husband because certainly in the past actually, when I was at medical school and probably you as well, we used to call the vaginal and vulva symptoms related to the menopause, VVA or vulvovaginal atrophy. And actually looking up the word atrophy in the dictionary just means withering and wasting away. And as a menopausal woman, I don’t want to think that I’m withering and wasting away. So quite rightly, the terminology was changed to GSM, which stands for genitourinary syndrome of the menopause, and that was good for two reasons. Firstly, it doesn’t define us as being atrophic, but also more importantly, it encompasses urinary symptoms of the menopause. And a lot of people, myself included, don’t always or didn’t always think about it. And of course, we’ve got estrogen and testosterone receptors in our urinary system and our pelvic floor. So a lot of women, and we know from studies, the majority of women actually have symptoms related to GSM and we know the minority of women receive treatment, but the majority of women will have symptoms which can include urinary symptoms. And women are more prone to have urinary tract infections when they’re menopausal. So looking at giving localised, plus or minus systemic hormones, is likely to really reduce the need for antibiotics. And that’s where I sort of finally approached you didn’t I and say, can we look at this a bit more closely because it’s so common and antibiotic prescribing in women is so common, especially postmenopausal women. And so I’m delighted that you’ve actually listened, Chris, because there’s a huge unmet need, isn’t it, really, for women?

Professor Chris Harding [00:18:11] Yeah. So this is what really attracted me to the project that we’ve been planning, which is the ‘need’ – there is really a problem. You know, you start any kind of research by thinking, well, what’s the size of the problem? The hormonal influence on urinary tract infections is really under researched. I think we don’t know anywhere near enough about this. So I think when you look at the studies, I think we’ve established that using estrogen topically inside the vagina will reduce the frequency of urinary tract infection episodes. But I think the conception that systemic HRT doesn’t help is probably something that you can challenge given how systemic HRT has changed over the last couple of decades. When we look at the evidence, when we collate the evidence for, you know, a hormonal effect with regards to urinary tract infections, a lot of the papers are two, three decades old and there’s been nothing new since. So it’s really interesting to have a look and see how the modern methods of systemic hormone replacement might affect the urinary tract infection frequency. And I think one thing I’ve noticed since we started talking is that the urinary symptoms as part of the complex that is menopause, perimenopause, it seems a bit underplayed to me. And I think, you know, that’s something that perhaps we can change in terms of just getting it out there. And, you know, some women just think that having a urinary tract infection is just ‘oh it’s just part and parcel of being a woman, isn’t it?’ Well, you know, like I said at the start, for 50% of the female population who will never have a urinary tract infection, it’s not. So in those who are getting recurrent episodes, perhaps we can look for reasons why that is.

Dr Louise Newson [00:20:01] I think you’re absolutely right. I mean, I was reading a study recently and it takes about a third of women five years or more to actually consult with a healthcare practitioner if they’ve got urinary symptoms related to their menopause. And that isn’t a surprise, really, but it’s really sad because the treatment is very easy for a lot of women. And a lot of women tell me that they can’t run, they’re not exercising, or they’re even coughing or sneezing because they get a bit of leakage and they think, ‘Oh, it’s just because I’m getting old. I’m now 56 or I’m 62’. Well, that’s not old at all. And they’ve never seen anyone. They’ve never thought of any treatment at all. And often when you say to them, “do you have any symptoms related to vaginal dryness?” And it doesn’t have to be dryness, it could just be some irritation or some itchiness or some soreness or some discomfort or some people have more discharge actually. And they say, “Oh yeah, that’s just part of getting old as well”, and never think that the two could be associated. And so it’s really important. But also I think it’s important that us as healthcare practitioners ask the questions because the symptom questionnaire, as you’ve seen it, the one we use in our clinic, about three or four months into opening my clinic, I actually added two symptoms to the questionnaire. One was urinary symptoms and the other was vaginal dryness because they weren’t on the questionnaire and women weren’t coming forward with those as symptoms. But every time I directly asked, they always said yes. So I thought, right, I’m going to add the question. So then I don’t forget to ask in the consultation and the women will be primed. And actually then the women seem very grateful that it’s a way into talking about it because we’re all very good as women talking about our symptoms, but we’re not so good at talking about our vaginas or even urinary symptoms. And I think it might be Chris, because we just think that’s just part of being a woman. And it’s wrong, isn’t it?

Professor Chris Harding [00:21:51] No, absolutely. I couldn’t agree more with that. I think, you know, just accepting these as part and parcel of ageing is just incorrect. But, you know, the medical profession has got a role to play here and that we can educate and shine a spotlight on these symptoms. And, you know, it doesn’t take much to explain in very simple terms to any patient why vaginal dryness and UTI’s are linked. And, you know, you’ve got to highlight the change in the bacteria in the vagina as probably the chief cause. And, you know, I think the changing the hormonal status in the vagina will – I mean, I’ll just use very simple terms. I say, you know, “the hormonal status of the vaginal tissues changes. The good bacteria are outcompeted by the bad bacteria and the bad bacteria migrate from vagina to urethra and then into the bladder. And before you know it, there’s a urinary tract infection.” And you know, that little spiel there took about 20 seconds and you’ll be amazed – well you wouldn’t be – but a lot of people would be amazed how many women don’t know this. And I think shining a spotlight on the symptoms by asking about them further reinforces, as you say, the relative ease with which we can do things to help.

Dr Louise Newson [00:23:04] I think it’s so right. I reached out to Sepsis UK a few years ago and we were trying to, I was trying to work out the incidence of urosepsis in women because sepsis secondary to urinary tract infection is not insignificant and it’s a lot more common in older women, especially women in nursing homes. And we know that a lot of older women are not receiving any vaginal hormones at all. And vaginal hormones are very safe even for women who’ve had breast cancer because they just work locally, they don’t get systemically absorbed. So it’s almost I think we should be thinking, why are women not using vaginal estrogen rather than, you know, how bad do they have to be before we start it? Because certainly in patients that I’ve seen, and I have seen thousands of women, that the earlier they start it, the less likely they don’t have more severe symptoms. Whereas those women that have recurrent urinary tract infections, sometimes interstitial cystitis, really having a lot of problems, it can take sometimes a year, 18 months to reverse that pathology and improve their symptoms. So it’s always better to start almost too early than wait, I think.

Professor Chris Harding [00:24:14] Yeah. So that raises a couple of issues that I’m glad you’ve brought up. The first one is you talked about the early treatment, which is sufficient to eradicate infections. That’s so important. I’ve seen a lot of patients who’ve ended up with lifelong urinary tract symptoms and a lot of them remember an initial episode and perhaps, you know, that wasn’t completely resolved by the medical treatment they were given. And there’s some fairly novel thinking now in the UTI community and beyond, that there may be a concept of chronic urinary tract infection. So this is where perhaps the bacteria from the first infection or one of the initial episodes would kind of attempt to hide from the immune system by embedding themselves within the wall of the bladder. And that leads to sort of unremitting symptoms that are sometimes incorrectly called interstitial cystitis. And interstitial cystitis really is a kind of diagnosis of exclusion once you’ve excluded every other cause. And this again, goes back to the small number of urinary tract symptoms that are in existence that I alluded to earlier. And I just wonder whether or not, you know, there are more of these women than we appreciate with chronic embedded urinary tract infections. And that might be a separate entity. And it would be brilliant, wouldn’t it, to avoid the development of these kind of chronic infections. You know, you can get a chronic infection in almost any body tissue or cavity. And I’m sure the urinary tract is no different at all. And I think the prevention, you know, the aspect of prevention is absolutely vital here. You know, and this is where we can start the conversation about the safety and efficacy of these preventative agents. You talk about topical, vaginal estrogen. Well, it’s virtually risk free. You know, even you know, I have oncology colleagues now who are really, really not at all concerned about using vaginal estrogen in estrogen receptor positive breast cancer patients, which highlights just the complete zero absorption from vaginal tissues. This is having a local effect. You know, we’ve done some work in the lab in Newcastle which shows actually what this is doing is this is activating part of your immune response, but your initial, what we call your innate immune response. And so we have grown up kind of vaginal tissue cultures in the lab, treated them with estrogen and shown that these vaginas, they release these things called antimicrobial peptides, which is small proteins which just hammer holes into the cell wall of E-coli. So this effect is almost certainly a local effect because there’s just no systemic absorption. And maybe this is why the old HRT, systemic HRTs, were not effective against urinary tract infection. And it remains to be seen whether the newer preparations, whether or not they can be. But this is why we’ve always got to keep researching this because, you know, reliance on data that’s 20, 30 years old is just not good enough in today’s society.

Dr Louise Newson [00:27:28] Yeah, I think it’s very interesting. So we know that about a fifth of women who use systemic HRT still need to use local vaginal HRT. You know, and I think you’re right. I think the way that it works is different. We know that systemic hormones, the systemic estradiol, can improve the immune system, but actually there are different ways of our immune system working. And I think for some women they need a higher concentration in the vagina that will obviously go into the urinary system. But I think you’re right, you can have a different way of action. And then for some women, you can give them all the vaginal estrogen in the world, but it doesn’t work well enough until they’ve got systemic, too. So it’s very important that even women who have systemic HRT, they might think, ‘Oh, I don’t need a small dose of localised vaginal estrogen’, but often it can make a huge difference, especially for people who have a lot of urinary symptoms. We certainly find that using both can really be very life changing actually for a lot of women because there is, as you say, so much suffering and people really can reach the end of the road because of the way that they’re feeling, which sounds very dramatic. But for any of you listening who’ve had severe urinary tract infections, and especially when they’re recurrent, then it can just really disable people in all sorts of ways.

Professor Chris Harding [00:28:48] No, I think that’s a point that deserves underlining the potential need for both systemic and local hormone replacement. You know, I can’t stress that enough, but yet you still do get patients who have concerns about exogenous hormones and in the field of urinary tract infections, you know, there are other options. There are other well proven preventative options. If patients didn’t want to use, you know, systemic and local hormone replacement, you can talk about urinary antiseptics. You can talk about sugars such as the mannose that are protective. There are a range of different non-antibiotic treatments that will work and I think I use the phrase quite often, ‘I’ll show you the menu, but I won’t tell you what to pick’. I just show patients the evidence for and against these treatments. But when it comes down to showing them the evidence, you’ve got to explore efficacy, i.e. how good are they at preventing urinary tract infections but also safety. You know, there’s now a widespread acceptance of the safety profile of local vaginal estrogen, and I think we can be much more definite than we were in the past about the lack of absorption, the lack of side effects from this particular treatment. Because, you know, not just the research we’ve done, but the experience I have as a clinician leads me to conclude that really these are very, very safe preparations.

Dr Louise Newson [00:30:14] Yeah, absolutely. And I think that’s the most important thing is choice. And knowing that if one treatment doesn’t work, you can add in something else or you could substitute it. So it’s really important that people do get health advice and I’m really excited with the work that we’re doing together Chris, and I look forward to seeing how it goes from then forward, because we’re really hoping it will make a big difference. So before I finish, Chris, I’d really like to just ask three take home tips, if I may, so I’d be really keen for you just to summarise three things that if women are listening to this podcast and they are one of these women that have had recurrent or are still having recurrent urinary tract infections, what are the three things that you would recommend that they should do to help?

Professor Chris Harding [00:30:59] I think three take home messages would be one, urinary tract infections in the peri- and postmenopausal phase are not just part and parcel and something you need to just get on with and suffer with. I think there is a lot of hope out there in terms of research that’s going on in the fields of urinary tract infections. And, you know, as we sit here today, there are many, many proven treatments which we can discuss. My three bits of advice for women with recurrent episodes of urinary tract infection, or indeed urinary symptoms associated with the peri or menopausal phase would be I wouldn’t be reliant on the current diagnostics. I think if they think they’ve got a urinary tract infection, they almost certainly have. And one thing that I put a lot of stock by is their previous response to these antibiotics. I think they should discuss with their doctors means of preventing infections if they are classified as recurrent. They should realise that the bar for recurrent UTIs is not high; it’s two episodes in six months or three in a year. And I think that they should realise that the use of hormonal manipulation, particularly vaginal estrogens, is significantly protective and preventative against urinary tract infections and it’s something that can be taken alongside systemic HRT for the local effects I was pointing out.

Dr Louise Newson [00:32:32] Perfect.

Professor Chris Harding [00:32:33] That was about six take home messages wasn’t it?!

Dr Louise Newson [00:32:38] That’s fine. Still a multiple of three. So I’ll give you that. So thanks ever so much for your time, Chris, because I know how busy you are and I’m really grateful for you sharing and imparting some of your wonderful knowledge to others. So thank you very much.

Professor Chris Harding [00:32:49] It’s been an absolute pleasure. Thanks for inviting me.

Dr Louise Newson [00:32:54] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.