Urinary Tract Infections (UTIs) During Perimenopause and Menopause
Article written by Dr Emma Ginns and Dr Mari Walling, British Menopause Society Registered Specialists and BSLM Lifestyle Medicine Physicians, Co-founders of Lemala Health. June 2026
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
In this guide, we explore why urinary tract infections (UTIs) become more common during perimenopause and menopause, the important role of vaginal oestrogen, and the treatments and practical steps that can help reduce the risk of future infections.
Why do I keep getting urinary tract infections?
Many women notice that urinary tract infections (UTIs) become more frequent during perimenopause and after the menopause.
Some women have experienced very few urinary tract infections (UTIs) previously, only to find themselves needing antibiotics several times within a year. This can become a frustrating cycle, affecting sleep, intimacy, work, travel and day-to-day confidence.
Although antibiotics are important for treating a UTI, they do not address one of the reasons infections become more common during perimenopause and menopause. Falling oestrogen levels affect the bladder, urethra and vaginal tissues, making UTIs more likely.
Recognising the role of menopause is an important first step. For many women, treating the underlying hormonal changes can make a significant difference and help reduce the risk of future infections.
What is a urinary tract infection?
A urinary tract infection (UTI) usually develops when bacteria that normally live harmlessly around the bowel enter the bladder through the urethra (the tube that carries urine out of the body). Once in the bladder, the bacteria can multiply and cause an infection.
The most common symptoms include:
Pain or burning when passing urine
Needing to pass urine more often than usual
A sudden urge to pass urine
Passing only small amounts of urine
Pain or discomfort low in the abdomen
Cloudy, strong-smelling or occasionally blood-stained urine
Most uncomplicated UTIs affect the bladder (known as cystitis), although infection can sometimes spread to the kidneys and become more serious.
Some women experience recurrent urinary tract infections (UTIs). Most recurrent UTIs are new infections rather than the previous infection returning.
Why do UTIs become more common during menopause?
Understanding the underlying hormonal changes can help move beyond repeatedly treating infections towards reducing the risk of them occurring in the first place.
One of the biggest changes during menopause is the gradual reduction in oestrogen. Oestrogen plays an important role in keeping the bladder, urethra and vaginal tissues healthy.
As oestrogen levels fall:
the lining of the urethra becomes thinner and less resilient
the bladder lining becomes more vulnerable to irritation
the vagina becomes less acidic
protective lactobacilli reduce
bacteria are more able to grow and reach the bladder
bladder emptying may become less efficient
pelvic floor changes increase the likelihood of prolapse or incomplete bladder emptying.
Together these changes make urinary tract infections more likely.
Many women experiencing recurrent UTIs also have other symptoms of Genitourinary Syndrome of Menopause (GSM), including vaginal dryness, discomfort, bladder irritation, urgency or pain during intercourse.
How can UTIs affect everyday life?
Although UTIs are common, that does not make them any less distressing.
Many women describe living with a constant worry about when the next infection will occur. They may avoid long journeys, always know where the nearest toilet is, carry antibiotics when travelling or become anxious whenever bladder symptoms begin.
UTIs can also affect:
Sleep
Exercise
Sexual intimacy
Holidays and travel
Confidence at work
Emotional wellbeing
Some women are caught in a cycle of repeated antibiotics without knowing why the infections keep returning or what could be done to reduce the risk.
What increases the risk of recurrent UTIs?
Several factors can increase the likelihood of recurrent urinary infections, including:
Perimenopause and menopause
Previous urinary tract infections
Vaginal atrophy due to low oestrogen
Sexual intercourse (for some women)
Spermicide use
Diabetes
Urinary incontinence
Pelvic organ prolapse
Incomplete bladder emptying
Urinary catheterisation
Often several of these factors occur together.
Treating the cause, not just the infection: the role of vaginal oestrogen
One of the most important advances in managing recurrent UTIs after menopause is recognising the role of vaginal oestrogen.
Rather than simply treating each infection with antibiotics, vaginal oestrogen helps restore the health of the tissues that naturally protect against infection.
By improving the vaginal environment it can:
increase protective lactobacilli
restore a more acidic vaginal pH
strengthen the tissues of the vagina and urethra
improve the body's natural defence against bacteria
reduce the risk of future urinary tract infections.
NICE recommends considering vaginal oestrogen for postmenopausal women with recurrent UTIs when appropriate.
Unlike systemic HRT, vaginal oestrogen works mainly within the local tissues and can usually be used whether or not you are taking HRT for menopause symptoms, and in some women in whom HRT may not normally be advised.
It is available as pessaries, vaginal tablets, creams and vaginal rings. The most suitable preparation depends on your symptoms and personal preference.
What else can help?
Alongside vaginal oestrogen, other measures may help reduce the risk of infection.
These include:
Keeping well hydrated
Avoiding delaying passing urine
Emptying the bladder after sexual intercourse if this is a recognised trigger
Avoiding spermicides where appropriate
Managing constipation
Treating urinary incontinence or prolapse where appropriate
Managing diabetes if present
Some women ask about cranberry products, probiotics or D-mannose. While some women choose to use these, the evidence supporting them is less consistent than for vaginal oestrogen.
When should I seek medical advice?
If you think you have a urinary tract infection, it is important to seek medical assessment so that the diagnosis can be confirmed and appropriate treatment started if needed.
You should seek prompt medical attention if you develop symptoms such as fever, pain in your back or side, vomiting, or feel generally very unwell, as these may suggest a more serious kidney infection.
If you are experiencing recurrent UTIs or symptoms that continue despite treatment, it is worth discussing whether Genitourinary Syndrome of Menopause (GSM) or other contributing factors could be increasing your risk.
If you have another long-term health condition, such as chronic kidney disease, your assessment and menopause treatment should be tailored to your individual circumstances. Although research in this area remains limited, it is important that both your kidney health and menopause are considered when planning your care.
Further support and information
https://www.lemalahealth.co.uk/resources/understanding-genitourinary-syndrome-of-menopause-gsm
https://www.lemalahealth.co.uk/resources/what-to-expect-after-starting-hrt
https://www.lemalahealth.co.uk/resources/menopauseaftercancer
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