- Hormonal changes during menopause, particularly the drop in estrogen, increase the risk of bladder infections and UTIs.
- Simple lifestyle adjustments such as staying hydrated, consuming a balanced diet, and maintaining regular exercise can significantly reduce the risk of bladder infections during menopause.
- Consulting with healthcare providers about treatments like hormone replacement therapy and taking preventive measures can help manage and reduce recurrent UTIs.
You’re probably aware that menopause can affect many different parts of your body. Most people have heard of hot flashes, brain fog, and some of the other symptoms that signal the end of the menstrual cycle. But did you know it can also impact your urinary health? It’s true—and it’s a very common issue as you move through perimenopause into the postmenopausal years. In fact, this cluster of urinary and vaginal symptoms—including dryness, irritation, and recurrent infections—is known as genitourinary syndrome of menopause (GSM).
What’s happening? As estrogen levels fluctuate during perimenopause and remain lower after menopause, the tissues in your urinary tract begin to thin. This thinning, called urogenital atrophy, weakens your body’s natural defenses and makes you more prone to urinary tract infections (UTIs). UTIs—also known as bladder infections—occur when bacteria enter the urinary tract, causing symptoms like burning, frequent urination, and pelvic discomfort. While anyone can get them, they tend to occur more often during and after menopause.
Recent research also shows that menopause alters the bladder’s microbiome, reducing protective bacteria and increasing microbial diversity. Both changes are linked to a higher risk of recurrent UTIs. Estrogen plays a key role in supporting a healthy vaginal microbiome by encouraging lactobacillus growth, which helps maintain a low (acidic) vaginal pH that prevents harmful bacteria from taking hold. When estrogen drops, these beneficial bacteria decline, pH rises, and infection-causing microbes can flourish. This microbial imbalance, known as dysbiosis, creates an environment ripe for infection.
Understanding these changes—and when they’re likely to occur—is the first step to staying on top of your health. The more you know about how menopause impacts your bladder, the better prepared you’ll be to manage and prevent issues.
Understanding bladder infections and UTIs during menopause
Bladder infections or UTIs can become more frequent during menopause. Hormonal changes, especially the drop in estrogen, affect how your urinary system functions and responds to bacteria. Estrogen normally supports a lactobacillus-dominant vaginal microbiome that keeps vaginal pH low and wards off harmful bacteria. When estrogen levels drop, the protective bacteria decline, vaginal pH rises, and pathogens are more likely to thrive—setting the stage for infection.
What will you notice about bladder infections during menopause?
The symptoms often feel like an escalation of general urinary discomfort. They may come on gradually or appear suddenly, and they’re often more noticeable as estrogen levels fluctuate, leading up to menopause.
What do bladder infections feel like?
Many women describe it as a sharp, irritating burn while urinating, often paired with:
- Urgency: the need to urinate right away
- Frequency: urinating more often, sometimes with little output
- Pelvic pressure or discomfort
- Cloudy or strong-smelling urine
What happens in the body?
As estrogen levels drop, the tissues in the vagina and urethra become thinner, drier, and more fragile. The natural balance of protective bacteria, like lactobacillus, also shifts, allowing harmful bacteria to grow more easily. This microbial imbalance—called dysbiosis—not only affects the vagina but also the bladder. Studies in postmenopausal people confirm that reduced estrogen leads to fewer lactobacillus species and a more infection-prone bladder environment. Pelvic floor muscles may weaken, leading to incomplete bladder emptying, which allows bacteria to pool and increases infection risk.
Who is most affected?
While anyone can develop a UTI, people are most at risk after menopause. A shorter urethra makes it easier for bacteria to travel to the bladder, and lower estrogen levels increase susceptibility. People with a history of UTIs or urinary incontinence are more likely to experience repeat infections during perimenopause and after menopause.
At what age can bladder infections start?
While UTIs and bladder infections can happen at any age, they can become more frequent when your hormones begin to fluctuate during perimenopause. Perimenopause is the name for the transitional years leading up to menopause, which can begin in the 40s. Many people begin to notice changes in their urinary function during this time.
The risk increases significantly in your 50s and 60s, particularly in the postmenopausal years when estrogen levels are consistently low. People reach menopause, defined as one year without a menstrual period, at different times, but the average age is 51 in the U.S.
How common are bladder infections during menopause?
Very common. Approximately 60% of people transitioning through menopause will experience at least one urinary tract infection (UTI). Studies also show that postmenopausal people with a history of UTIs or urinary incontinence are at higher risk for recurrent infections.
In which stage of menopause do they occur?
Bladder infections can happen at any point—during perimenopause, menopause, or postmenopause. They’re most common in the postmenopausal stage when estrogen has significantly declined and the urinary tract is more vulnerable.
Causes and risk factors of bladder infections and UTIs during menopause
The shift in hormones, along with age-related changes and individual health factors, creates an environment that can increase your risk of bladder infections and UTIs. Let’s take a closer look at what’s really going on behind the scenes.
Hormonal shifts increase the risk of infection
The chance of UTIs increases because lower estrogen levels can lead to vaginal dryness, weakened urethral muscles, and less natural lubrication—all of which make the area more prone to irritation and infection. Estrogen also helps good bacteria thrive, keeping the vaginal pH acidic and protective. When estrogen levels drop, pH levels can rise, disrupting the balance and allowing harmful bacteria to grow.
Studies have shown that the genitourinary syndrome of menopause involves not just physical tissue changes but also microbial shifts that increase UTI risk. One clinical review found that estrogen deficiency reduces urethral tone and local immune defense, both of which increase bacterial susceptibility. Vaginal estrogen therapy has been shown to restore lactobacillus and lower UTI recurrence.
Genetic predisposition is a factor
Some people are simply more likely to experience recurrent bladder infections due to their genetic history. If your mother or sister struggled with frequent UTIs, you may be more prone to them, too. While research is still evolving, genetics may influence:
- How your immune system responds to bacteria
- The shape or structure of your urinary tract
- How your body maintains a healthy balance of microbes
Underlying health conditions could be contributing
Certain health conditions can raise your risk of UTIs even more.
- Diabetes can make it harder for your body to fight off bacteria.
- Autoimmune issues or any other condition that weakens the immune system can have a similar effect.
- Constipation, which becomes more common during menopause, can increase UTI risk. A study involving postmenopausal women found that chronic constipation, likely correlated with decreased hydration, was one of several factors linked to a higher risk of recurrent urinary tract infections.
- Bladder prolapse (also called cystocele) can also play a role. When the bladder shifts and presses into the vaginal wall, it can interfere with proper bladder emptying, upping the risk of infection.
Lifestyle factors could be an issue
Daily habits and routines can also affect how your urinary system functions. As we said, sexual activity can introduce bacteria into the urinary tract, especially when the vaginal tissues are thinner and drier than they used to be. Other lifestyle-related risks include:
- Reduced fluid intake could lead to concentrated urine and less frequent flushing of the urethra.
- Wearing tight or non-breathable clothing, such as synthetic underwear or leggings, can trap moisture and heat and increase irritation in the urinary and vaginal area.
- Frequent or prolonged use of incontinence pads or urinary catheters might be irritants. Catheterization, when part of a hospitalization, is one of the strongest risk factors for hospital-acquired UTIs.
- Smoking can weaken pelvic muscles and affect blood flow.
Aging is part of the issue
Over time, your pelvic floor muscles may weaken, making it more difficult to empty your bladder completely. Incomplete emptying allows bacteria to linger longer than they should. Menopause can also cause the urethra to shorten or shift slightly, leaving it more exposed and less protected. As we age, the immune system slows down, which means our body may not fight off infections as efficiently as it once did.
Smart ways to prevent UTIs and bladder infections during and after menopause
Bladder infections may be more common during and after menopause, but they’re not inevitable. With a few changes to your habits, you can reduce your chances of experiencing them.
Here are some practical ways to support your urinary health during this time:
- Stay well-hydrated: Drinking enough water helps flush bacteria out of your urinary tract before it can cause trouble. Aim for 6 to 8 glasses of water a day, unless your doctor advises otherwise. Experts shared that proper hydration can greatly decrease your chances of developing a UTI.
- Don’t hold in your urine: When you feel the urge to go, try not to delay. Holding it in for long periods gives bacteria more time to multiply and irritate your bladder.
- Prioritize gentle hygiene habits: Wipe from front to back after using the bathroom to prevent the spread of bacteria. Skip douches, scented soaps, and feminine sprays—they can disrupt your natural balance and increase irritation.
- Urinate after sexual activity: This helps flush out any bacteria that may have entered the urethra.
- Add bladder-friendly foods to your meals: High-fiber fruits, leafy greens, and whole grains can support digestion and reduce bladder irritation.
- Be mindful of what you wear: Choose breathable cotton underwear and avoid overly tight pants or synthetic fabrics that trap moisture.
- Keep up with regular check-ups: Visiting your healthcare provider on a regular basis can help catch potential issues early.
- Keep a symptom log if you’re prone to infections: Tracking when symptoms appear, how long they last, and what seems to trigger them can help you and your healthcare provider identify patterns that may be contributing to your condition.
- Talk to your doctor about vaginal estrogen therapy: If you’re dealing with recurring UTIs, your provider may recommend a low-dose vaginal estrogen cream, tablet, or ring to help restore tissue health in the vaginal and urinary tract. Studies suggest that topical estrogen can significantly lower the risk of recurring UTIs in postmenopausal women.
- Ask about preventive medications if infections keep coming back: Some women benefit from low-dose antibiotics taken regularly or after sex. Common options include nitrofurantoin or trimethoprim-sulfamethoxazole. ]
How bladder infections and UTIs are diagnosed
Getting the correct diagnosis is the first step toward feeling better. If something feels off with your bladder, it’s worth paying attention. The earlier you catch a bladder infection or UTI, the easier it is to treat.
Here’s what to watch for:
- A burning feeling when you pee.
- That constant, urgent need to go—even when your bladder isn’t full.
- Discomfort or pressure in your lower belly.
- Cloudy or strong-smelling urine.
- Incontinence, in the absence of other symptoms, also needs to be checked by a doctor.
During menopause, these symptoms might show up more often or feel more intense. But keep in mind—some of these symptoms can also come from other menopause-related changes, like vaginal dryness or an overactive bladder. That’s why checking in with your doctor is so important.
If any of these symptoms last more than a day, or you notice things like:
- Blood in your urine
- Fever or chills
- Pain in your back or sides
- Symptoms that just won’t go away
Don’t wait—call your healthcare provider if you think you have a UTI. Quick action can prevent it from getting worse. Diagnosis usually takes just a day or two and may include a urine sample, a physical exam, and a chat about your symptoms. In the meantime, your doctor might decide to start UTI treatment immediately and advise you to follow up if there is no significant improvement in the next 24 to 48 hours. If UTIs keep coming back, your doctor might run extra tests to rule out other issues.
It’s also possible to have a UTI without clear symptoms, especially after menopause, so regular check-ups can be super helpful. Your provider might check estrogen levels or look for tissue changes that could be contributing.
One simple tip: Keep a symptom journal. Tracking things like discomfort, bathroom frequency, and urine changes can help your doctor see patterns. And if you’re facing frequent UTIs, don’t just tough it out—there are longer-term solutions, like preventive treatments or hormone therapy, that can really help.
Medical treatments and professional advice for bladder infections
When it comes to treating bladder infections during menopause, your healthcare provider has several helpful options, ranging from hormone therapy to antibiotics and newer treatments that help reduce the risk of recurrence:
Can hormone replacement therapy treat bladder infections and UTIs?
Hormone replacement therapy (HRT), or MHT (menopausal hormone therapy, can’t treat infections, but it can be an effective way to prevent them during menopause, especially when vaginal dryness and tissue thinning are part of the problem.
Low-dose vaginal estrogen therapy helps restore the health of the urethral and vaginal tissues, improving moisture, elasticity, and tissue strength. These localized treatments are not the same as full-body hormone therapy and are considered safe for most people.
Common forms include:
- Vaginal creams like Estrace®
- Tablets like Vagifem®
- Rings like Estring® (a flexible device inserted vaginally and replaced every 3 months)
How to treat a UTI
If you’re treating an active bladder infection, antibiotics are typically the first line of treatment. These medications help eliminate bacteria and alleviate symptoms like burning, urgency, and pelvic pressure.
Commonly prescribed antibiotics include:
- Nitrofurantoin (Macrobid®) – Often used for uncomplicated UTIs
- Trimethoprim-sulfamethoxazole (Bactrim®, Septra®) – Effective for many bacterial strains
- Fosfomycin (Monurol®) – A single-dose option that’s easy to take
- Cephalexin (Keflex®) – Sometimes used for mild or recurrent infections
- Ciprofloxacin (Cipro®) or Levofloxacin (Levaquin®) – Generally reserved for more resistant cases
Advanced therapies and new treatments
For women dealing with recurrent or treatment-resistant infections, newer therapies may offer additional support.
One promising option is pivmecillinam, a next-generation antibiotic that is already used in Europe and is expected to become more widely available in the U.S. by 2025. It has shown success in treating UTIs that don’t respond well to standard antibiotics.
Other emerging therapies include:
- Targeted probiotics, such as Lactobacillus crispatus, which may help maintain a healthier balance of bacteria in the urinary and vaginal tract
- Immune-supportive therapies aimed at improving your body’s ability to fight off infections are still under investigation.
- Methenamine is a prescription anti-infective medication that has been shown to help prevent UTIs in some people. It can be an effective alternative to antibiotics since it won’t cause the bacterial resistance that can come with prolonged antibiotic use.
Your doctor may also recommend consulting a urologist or urogynecologist if you experience frequent or complex UTIs.
Don’t skip regular check-ups. These visits help monitor your urinary health, catch infections early, and keep your treatment plan on track.
Lifestyle adjustments for bladder infections and UTIs
Yes—small daily choices can make a big difference when it comes to bladder health during menopause:
- Nutrition and hydration can help a ton. Staying hydrated helps flush bacteria from your urinary tract, while a perimenopause diet rich in fiber, fruits, vegetables, and whole grains supports digestive and immune health. Avoiding bladder irritants like alcohol, caffeine, spicy foods, and artificial sweeteners may also help reduce discomfort.
- Exercise and movement can support pelvic floor strength, digestion, and circulation—all of which contribute to better bladder function. Aim for gentle movement most days, like walking, yoga, or pelvic floor exercises (Kegels), which can help prevent incontinence and support bladder control.
- Stress and sleep management matter, too. Chronic stress and poor sleep can weaken the immune system and disrupt hormone balance, potentially raising the risk of infection. Mindful activities like meditation, stretching, or even a calming evening routine can help restore balance. Prioritizing 7 to 9 hours of quality sleep also gives your body time to repair and regulate.
Lifestyle shifts may not prevent every infection, but they can tip the odds in your favor—and help you feel more in control of your health during menopause.
Natural remedies for preventing bladder infections and UTIs: Dos and don’ts
Some natural remedies can complement medical treatment for bladder infections during menopause, but not all options are backed by strong science. Here’s what to know.
What may help
- Some studies suggest that cranberry products, such as juice or supplements, may help prevent UTIs by making it more difficult for bacteria to adhere to the bladder wall.
- Probiotics, particularly those with Lactobacillus, may support a healthier vaginal microbiome.
What to be cautious with
- Herbal remedies like uva ursi, goldenseal, or oregano oil are often promoted for urinary health, but evidence is limited, and some may interact with medications or cause side effects.
What to avoid
- Steer clear of douching, vaginal sprays, or scented hygiene products. These can disrupt the natural balance of bacteria and lead to increased irritation. Also, never use natural remedies in place of antibiotics if you already have symptoms of an active infection.
Natural options can support prevention, but they’re best used in conjunction with guidance from your healthcare team. When in doubt, stick to science-backed strategies and always talk to your doctor before starting any herbal supplements to determine what’s safe and effective for you.
How to deal with bladder infections and UTIs during menopause
By now, we’ve discussed the causes of bladder infections during menopause, strategies to reduce your risk, and available treatment options. But what should you actually do when one starts?
Start by recognizing the signs described earlier. Mild symptoms may improve with rest and hydration, but if they last more than 24 hours—or you notice fever, chills, nausea, or blood in your urine—it’s important to contact your healthcare provider, who may do a test to confirm the infection, prescribe antibiotics, or recommend follow-up care.
While you recover, repeat the basics:
- Drink plenty of water
- Avoid bladder irritants
- Use a heating pad on your lower abdomen for bladder pain
- Rest when you can
And if this is your second or third infection in a short span, it might be time to revisit the preventive steps we discussed earlier—like vaginal estrogen therapy, pelvic floor exercises, or adjusting your hygiene habits. Recurrent infections are also sometimes treated with a daily low-dose antibiotic or an antibiotic for after sexual activity if that seems to be the trigger. You might also be referred to a urologist to figure out why the infections keep coming back.
Take charge of your urinary health with Noom
As we’ve explored, bladder infections can significantly disrupt your daily routine. But with the right know-how and support, you can prevent and manage them. Simple steps, such as staying hydrated, eating well, and staying active, can make a significant difference. About 60% of women will experience a UTI in their lifetime, and hormonal changes can increase that risk. That’s why teaming up with your healthcare provider and making some lifestyle tweaks can be so helpful.
Here at Noom, we get that feeling your best isn’t just about tackling one symptom at a time—it’s about your overall wellness. Our personalized approach helps you develop habits that support your urinary health and all aspects of menopause. Want to feel your best during this new chapter? Discover how Noom can support you every step of the way.
