Getting walloped with repeat urinary tract infections, or UTIs, might be something you associate with having lots of sex. (Or, perhaps, it brings back memories of an adventurous string of hookups with a handful of new partners.) While it’s true that sex can make it easier for UTI-causing bacteria to scooch into your urethra (or pee tube), it’s far from the only risk factor. In fact, the peeing-flames infection can often surface in midlife, starting around perimenopause (a.k.a. the on-ramp to menopause), for a reason that has nothing to do with sex: hormone changes and their effect on the vagina and urinary tract.
UTIs are among the most common infections to hit women, with 50% to 60% of women getting one in their lifetime, and outside of a surge among folks ages 14 to 24, they become more prevalent with age. As does the rate of recurrence, or how often a UTI crops up again after treatment, which is around 19% to 36% in premenopausal people and jumps to 55% postmenopause. That spike is largely the result of genitourinary syndrome of menopause, or GSM, which describes a set of symptoms in your nether regions (like vaginal dryness, pain with sex, and urinary frequency and urgency) that can occur with dropping estrogen levels in perimenopause, too. As many as 70% of people will deal with GSM by the time they hit menopause, but because of the stigma shrouding its symptoms, it often goes underdiagnosed and undertreated—which leaves plenty of perimenopausal folks playing whack-a-mole with recurrent UTIs.
Below, experts break down why UTIs can be so prevalent and persistent in perimenopause and beyond, and share the solutions that get to the root of the problem.
The hormone fluctuations of perimenopause can increase your risk for UTIs in more ways than one.
A single UTI turning into an onslaught of them is not a problem unique to perimenopause—certain people have a stickier bladder lining that lets UTI-causing bacteria (like E.coli) hang around, while others have an immune system or gut microbiome that makes it easier for the bad microbes to proliferate. (All the while, some of the bacteria behind UTIs is becoming resistant to the antibiotics we use to treat them, which can keep ’em coming back.)
But even if you’re a person who hasn’t historically dealt with UTIs, you can run up against them in perimenopause because of changes to the vulva, vagina, and urinary tract that unfold with GSM, as estrogen levels first go haywire and then plummet.
Here’s why: Estrogen keeps your vulva and vagina in their optimal states—thick, bouncy, and moist. A decline in this hormone can cause the oft-cited vaginal dryness of menopause, alongside thinning and shrinking of the vulva, which can be irritating and itchy. What you might not know is that there are also estrogen receptors throughout the urinary tract, so “with loss of estrogen, the tissues in parts of the bladder and around the urethra tend to thin too,” Mindy Goldman, MD, an ob-gyn in San Francisco and chief clinical officer at Midi, a Telehealth platform for midlife, tells SELF. These changes can, in and of themselves, trigger pain with peeing or spark a need to pee more often or urgently—GSM symptoms that can mimic a UTI, says Sameena Rahman, MD, an ob-gyn in Chicago and perimenopause expert at women’s health app Flo. But at the same time, all the tissue-shriveling can increase your susceptibility to an actual UTI: It deflates the protective barrier surrounding your urethra, making it easier for bacteria in your vagina and anus to crawl on over.
