UTIs and perimenopause/menopause: what’s the link?

Discover why you may be prone to UTIs during perimenopause and menopause and how to manage them

• Around 50-70% of women will experience a urinary tract infection (UTI) at some point in their lifetime
• What are UTIs, and why can they occur during perimenopause and menopause?
• How vaginal hormones can help

Do you have an urge to pass urine more often than usual, or are you experiencing pain or a burning sensation when going to the toilet? Then you may have a urinary tract infection (UTI). UTIs affect up to half of women at some point in their lives [1], and data shows that over five year, UTIs led to more than 800,000 hospital admissions in England alone [2].

But what are UTIs, and how can they be connected to hormones – and crucially, what can you do about them?

What are UTIs?

UTI is an umbrella term for infections affecting your urinary tract, including your bladder (an infection known as cystitis), your urethra, (an infection known as urethritis), or your kidneys (an infection known as pyelonephritis). Common symptoms include:

• Discomfort, pain or a stinging/burning sensation when you pass urine
• Needing to pass urine more frequently
• Feeling like you need to go to the toilet, even when your bladder is almost empty
• An ache in your lower tummy
• Cloudy, dark and/or strong-smelling urine, which may contain blood
• A high or unusually low temperature
• Confusion or worsening brain fog
• Fever, nausea and vomiting – if this happens it’s important to see a doctor

RELATED: Urinary tract infections in women with Professor Chris Harding

What causes UTIs?

UTIs are usually caused by bacteria entering your urinary tract via your urethra, the tube that carries urine out of your body. Women have a shorter urethra than men, which means bacteria are more likely to reach your bladder or kidneys and cause an infection.

Things that increase the risk of bacteria getting into the bladder include pregnancy, sex, conditions blocking the urinary tract such as kidney stones, conditions that make it difficult to empty your bladder, urinary catheters (a tube in your bladder used to drain urine), having a weakened immune system, not drinking enough fluids and not keeping your genital area clean and dry.

RELATED: How to keep hydrated during menopause

What’s the link between UTIs and menopause?

Your urinary tract is lined with cells that have receptors for oestradiol (a form of oestrogen), progesterone and testosterone. The receptors use these hormones to keep your tissues strong and healthy. Oestradiol has been shown to stimulate secretion of antimicrobial substances in your bladder and vaginal cells, which then improves immunity and reduces the risk of infections [3]. When hormone levels fall during perimenopause and menopause, your urinary tract lining can thin and your body’s ability to fight off bacteria is reduced, which can increase the risk of urinary-related symptoms and recurrent UTIs [4].

You may also experience thinning and soreness of the tissues around your vulva and vagina, leading you to change your wiping habits after using the toilet because it causes discomfort, which can also increase the chance of infection.

It can be common to experience symptoms of a UTI during perimenopause and menopause even if you have no actual infection (cystitis), due to the lack of hormones in your bladder and surrounding tissues.

RELATED: More than ‘a little vaginal dryness’: how vaginal hormones can transform lives

I have a UTI. What should I do?

There are a few self-help measures that can help ease the symptoms of a UTI and reduce the risk of recurrence, including drinking plenty of water and avoiding caffeine, fizzy drinks or fruit juice, as these can make symptoms worse. Over-the-counter painkillers such as paracetamol or ibuprofen can help with any pain or high temperature.

When should I see a doctor about a UTI?

If your symptoms persist, or you begin to feel unwell, develop a fever, nausea or vomiting, you should contact your doctor, as you may need to take antibiotics.

How can I try to prevent getting a UTI?

• Use vaginal hormones regularly
• Aim to drink two litres of water each day and limit alcohol and sugary food and drink
• Wipe from front to back after using the toilet
• Keep your genital area clean and dry
• Try to go to the toilet after sex to flush away any bacteria
• Avoid perfumed products that can cause irritation
• Avoid tight-fitting synthetic underwear
• Avoid using condoms or diaphragms with spermicidal lube, use non-spermicidal lube instead

Can replacing hormones help with UTIs?

HRT replaces hormones throughout your body when levels fluctuate and fall during perimenopause and menopause, and can bring relief to your symptoms.

However, vaginal hormones – which can be used with or without HRT – can reduce the frequency of UTIs in women and should be considered first line treatment for more women [5, 6]. Vaginal hormones can also be used safely and effectively in young women who are not perimenopausal or menopausal with good effect.

Vulval, vaginal and urinary symptoms associated with perimenopause and menopause, including UTIs, are collectively known as genitourinary syndrome of menopause (GSM). GSM symptoms can be distressing; they often worsen with time and usually persist. Despite GSM being common and often having a negative effect on women’s quality of life, it is still underdiagnosed and often treated too late, or not at all [7].

RELATED: Unpicking UTIs and the role of hormones with Dr Rajvinder Khasriya

Topical oestrogen

An effective solution is to apply oestrogen vaginally where it can get absorbed through to the urinary tract and bladder [8,9]. This is known as ‘vaginal’, ‘topical’ or ‘local’ oestrogen, and is not the same as the oestrogen you take as part of your HRT; vaginal oestrogen treatments can be taken safely for a long time (usually for ever) with no associated risks [10].

There are numerous brands available, which use one of two types of oestrogen (oestradiol or oestriol) and come in either a pessary, a cream or gel, or a soft silicon ring you insert inside your vagina.

RELATED: Vaginal hormones: what you need to know

Prasterone/DHEA

Another option is to use a hormone called prasterone (also known as DHEA), which your body produces naturally.  This is available as a daily pessary that, once inserted into your vagina, releases the prasterone, which is then converted to both oestrogen and testosterone. It often works really well to improve symptoms and reduce the likelihood of UTIs occurring.

There is good evidence that women who are prescribed prasterone have a lower incidence of UTIs [6].

A pilot study from Newson Research showed that while 42% of perimenopausal and postmenopausal women reported an improvement in urinary symptoms using HRT, testosterone and vaginal oestrogen, 61% reported an improvement using HRT, testosterone and vaginal prasterone [11].

You should speak to your healthcare professional for an individualised conversation about which type, formulation and dose of hormones would be best for your symptoms, medical history and personal preferences.

Newson Research has worked with the British Society for Sexual Medicine to help healthcare professionals diagnose and manage GSM – you can read the guidance here.

RELATED: Urinary incontinence in menopause: are you ignoring the symptoms?

Resources

The Urology Foundation: UTI information service and helpline

References

1. EAU (2023) Urological infections. European Association of Urology. https://uroweb.org 
2. NHS Digital (2023) ‘Hospital admissions relating to urinary tract infections’
3. Beerepoot M. A. et al. (2013), ‘Non-antibiotic prophylaxis for recurrent UTI; a systematic review and meta-analysis of RCTs’, Journal of Urology, 190 (6), pp. 1981–9. doi:10.1016/j.juro.2013.04.142
4. Luthje P., Browner H., Ramos N.L. et al. (2013), ‘Estrogen supports urothelial defense mechanisms’, Science Translational Medicine, 5 (190); 190ra80 doi:10.1126/scitranslmed.3005574
5. Meister M.R., Wang C., Lowder J.L., Mysorekar I.U. (2021), ‘Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections’, Female Pelvic Med Reconstr Surg, 1;27(1):e39-e44. doi: 10.1097/SPV.0000000000000790.
6. Rubin R., Sanaee M., Yee A., Moyneur E., Dea K., Dury A.Y. Prevalence of urinary tract infections in women with vulvovaginal atrophy and the impact of vaginal prasterone on the rate of urinary tract infections. Menopause. 2025 Mar 1;32(3):217-227. doi: 10.1097/GME.0000000000002485.
7. Kingsberg S.A., Krychman M., Graham S., Bernick B., Mirkin S. (2017), ‘The women’s EMPOWER survey: identifying women’s perceptions on vulvar and vaginal atrophy and its treatment’, Journal of Sexual Medicine, 4(3), pp. 413–24. doi:10.1016/j.jsxm.2017.01.010
8. Anger J. et al (2019),‘Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline’, J Urol. 202(2):282-289. doi:10.1097/JU.0000000000000296
9. Palacios S., Combalia J., Emsellem C., Gaslain Y., Khorsandi D. (2020), ‘Therapies for the management of genitourinary syndrome of menopause’, Post Reproductive Health; 26 (1):32-42. doi:10.1177/2053369119866341
10. The NAMS 2020 GSM Position Statement Editorial Panel (2020), ‘The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society’, Menopause, 27 (9) pp. 976–92. doi:10.1097/GME.0000000000001609
11. Jiang W., Peng B., Fowler A., Kamal A., Reisel D., Lewis R. Newson L. ‘Vaginal DHEA versus vaginal oestrogen for improving urinary symptoms in peri- and postmenopausal women: a pilot study’, USANZ 2025.