What Every Woman Needs To Know About UTIs

And smart tips for keeping them at bay.

Published August 21, 2023

illustration of woman trying to solve uti problem

Chiara Ghigliazza

Like it or not, midlife is accompanied by some unpleasant health changes. Hello, vision differences, colonoscopies and hot flashes. But you may be surprised and bummed to also notice an uptick in urinary tract infections (UTIs) in midlife. If so, you’re not alone. The classic hormonal changes of menopause are at work, contributing to an increased risk for UTIs. Plus, there’s often the absence of kids around the house, which may have you — voilà — enjoying more sex. Sadly, more sex boosts the odds of UTIs cropping up, at the very same time you’re muddling through menopause.

Enough already! Feel like you can’t catch a break?

Best to slow down, connect the dots and make sense of how the realities of this life stage feed off one another, slyly setting out a welcome mat for UTIs. Here, trusted medical professionals provide a UTI primer tailored to midlife women, addressing what you should know and what you can do.

What’s Going On

It’s important to appreciate that the urethra — the tube that carries urine from the bladder to outside the body — and the vagina are cozy neighbors. Alyssa Dweck, M.D., a board-certified gynecologist in Mount Kisco, New York, says, “Being born genetically female means the urethra is in close proximity to the vagina and rectal area.”

The length, not just the position, of the urethra matters, too, notes Renita White, M.D., a board-certified obstetrician and gynecologist in Atlanta: “Unlike men, women have short urethras.”

Dweck says bacteria can easily hop over from the rectum or the vagina and colonize the urethra and bladder, causing UTIs. And then that all-too-familiar urgency to pee happens, and the ongoing burning sensation ensues when peeing, as does the miserable inability to fully empty your bladder.

Why You May Be Experiencing More UTIs in Midlife

For those in midlife who get UTIs and want to understand their root causes, Dweck says there are many moving parts to consider. Most notably, estrogen decreases, resulting in increased vaginal dryness.

· Changes in skin

Dweck explains that during menopause, micro-abrasions are more likely to occur during sex because skin is thin and fragile due to low levels of estrogen. Through these miniature fissures, bacteria can make its way into the urethra.

· Changes in bacteria

White points out that estrogen plays an important role in maintaining the vaginal and vulval microbiome (bacterial environment). It’s perfectly normal to have a mix of different types of bacteria in the vagina, she says. “However, when estrogen levels drop during menopause, this leads to a change of the pH of the vagina and vulva, which can lead to a higher risk of bacterial overgrowth, leading to UTIs.”

· Changes in sexual habits

Dweck hears all the time from patients who tell her they were trying to “keep up” with their sex life or went on holiday and had more sex than usual — only to discover they’re stuck with cystitis (inflammation of the bladder) are very uncomfortable. She notes that this can occur at any age but is especially prevalent during menopause. The body is reacclimating after a hiatus of a sexual activity, she explains, and this reintroduction can cause some trouble — at least temporarily. White’s patients also report higher rates of UTIs when engaging in more sex. “The ‘bumping and grinding’ of sex can increase the risk of bacteria moving from the vagina, up the urethra and into the bladder,” she says. “This can increase the risk of bladder infections, a.k.a. UTIs.”

What to Do

If you’re plagued with a rise in UTIs corresponding directly with the delights of enjoying more sex in midlife, White says to talk with your doctor to learn about options — which could include vaginal estrogen cream supplements, antibiotics or probiotics.

Additionally, there are several easy interventions and personal practices you can adopt that can mitigate the risk of UTIs, Dweck says.

· Keep it clean

Dweck goes back to the basics and underscores the importance of urinating after intercourse, regardless of age. Wiping from front to back prevents rectal and anal bacteria from moving toward the urethra and is foundational to healthy urination habits, she adds.

· Consider cranberry supplements

Regularly taking a cranberry supplement could be helpful, says Dweck — not cranberry juice concentrate, she clarifies, but a real concentrated supplement. Cranberry has an ingredient that tends to make the bladder more slippery, she explains, and is thought to help minimize the changes of bacteria sticking around. Consult with your physician about the plethora of options available, including generic choices as well as popular brands such as AZO and Ellura.

· The secret to staying supple

Like faces in midlife, the vagina needs a strong dose of TLC and a daily moisturizer. “The best thing to do in midlife is to moisturize the vagina regularly,” Dweck advises, noting that she’s not referring to lubricants, which, although helpful, perform a different function. During menopause, estrogen levels drop and the vagina becomes progressively drier — often leading to more UTIs. With low levels of estrogen, the vagina grows less supple and elastic, and more susceptible to being abraded during intercourse. Micro-abrasions provide an entry point directly into the bloodstream and set the stage for bacterial contamination. Look for moisturizers with hyaluronic acid, a time-tested ingredient used in countless face and body creams. Dweck points out that there are many great drugstore vaginal-moisturizer options. Feeling DIY? She says that some people opt for coconut oil, a popular household item. Whatever you use, the trick is to apply it daily. “It’s not like a one-and-done type of thing,” Dweck notes. As always, it’s best to talk with your doctor about your symptoms and learn which moisturizer is best for you.

Have you suffered with UTIs? What did you do? Let us know in the comments below.

Kathryn Streeter is a freelance writer living in Washington, D.C. whose work has appeared in USA Today, The Washington Post, Islands, The Week and elsewhere. Learn more at KathrynStreeter.com.