Female Urinary Tract Infections

Urinary tract infections (UTIs) are very common in women. Most UTIs affect the bladder and cause symptoms such as burning or stinging when passing urine, needing to urinate frequently, urinary urgency and discomfort in the lower abdomen.

UTIs can occur at any age, but the reasons women develop them can change throughout life. Understanding these differences is particularly important for women who experience recurrent UTIs.

UTIs before menopause

Before menopause, UTIs are commonly related to bacteria entering the urinary tract. Factors that can increase the risk include sexual activity, previous UTIs, spermicide use and some bladder or anatomical factors.

Most uncomplicated UTIs can be treated effectively with a short course of appropriate antibiotics.

Simple measures such as staying adequately hydrated, not regularly delaying urination and urinating after sexual intercourse may be helpful for some women, although UTIs are not caused by poor hygiene.

Recurrent UTIs

Some women experience UTIs repeatedly. Recurrent UTI is generally defined as two or more UTIs within six months or three or more within a year.

If UTIs are recurring, it is important to confirm that the episodes are genuine infections, usually with urine cultures, rather than another condition causing similar symptoms.

The best prevention strategy depends on the individual woman and may include:

• identifying and addressing contributing factors

• ensuring the bladder empties properly

• vaginal oestrogen after menopause

• Hiprex (methenamine hippurate)

• a single preventative antibiotic taken after sexual intercourse

• low-dose antibiotic prophylaxis taken regularly

• other non-antibiotic preventative measures.

Post-coital antibiotics

For women whose UTIs are consistently triggered by sexual intercourse, taking a single low dose of an appropriate antibiotic shortly after intercourse can be an effective way of preventing recurrent infections.

This approach can be preferable to taking antibiotics every day because the antibiotic is used only when the known trigger occurs.

The choice of antibiotic depends on previous urine cultures, allergies, local antibiotic resistance and individual circumstances.

Low-dose antibiotic prophylaxis

For women who continue to experience recurrent UTIs despite other preventative measures, a low-dose antibiotic taken regularly may be considered.

This can be very effective at reducing the number of infections, but prolonged antibiotic use has disadvantages, including antibiotic resistance, side effects and the potential for changes to normal bacteria.

For this reason, long-term antibiotic prophylaxis is generally considered after other appropriate preventative measures have been discussed.

Hiprex (methenamine hippurate)

Hiprex (methenamine hippurate) is a non-antibiotic medication that can help prevent recurrent UTIs.

It works by being converted into an antiseptic substance in the urine, which makes it more difficult for bacteria to grow. Unlike traditional antibiotic prophylaxis, it does not work by directly killing bacteria and therefore may be useful as an alternative to long-term antibiotics.

Hiprex is taken regularly as a preventative treatment rather than as treatment for an active UTI.

It is not suitable for everyone, and your doctor will consider your kidney function, other medications and individual circumstances before recommending it.

UTIs around menopause

The risk of UTIs often increases during perimenopause and after menopause.

As oestrogen levels fall, the tissues around the vagina and urinary opening become thinner and the normal vaginal environment changes. There can be a reduction in the protective bacteria that help prevent harmful bacteria from growing.

These changes can make urinary infections more likely.

Women may also experience vaginal dryness, burning, discomfort with intercourse, urinary urgency or increased urinary frequency. These symptoms can sometimes resemble a UTI even when there is no infection.

Vaginal oestrogen

Vaginal oestrogen is one of the most effective ways to reduce recurrent UTIs in post-menopausal women when low oestrogen is contributing to the problem.

It is applied locally to the vagina, usually as a cream, tablet/pessary or ring. It helps restore the health of the vaginal and urinary tissues and encourages the return of protective vaginal bacteria.

This can reduce the likelihood of bacteria causing recurrent bladder infections and can also improve symptoms such as vaginal dryness, irritation and urinary urgency.

For post-menopausal women with recurrent UTIs, vaginal oestrogen is often an important part of a prevention strategy and may reduce the need for repeated courses of antibiotics.

Is vaginal oestrogen safe?

For most post-menopausal women who are suitable for treatment, low-dose vaginal oestrogen has minimal absorption into the bloodstream and is generally considered safe.

UTIs after menopause

After menopause, recurrent UTIs are often related to reduced oestrogen, although other factors can contribute.

These may include incomplete bladder emptying, pelvic organ prolapse, urinary incontinence, diabetes, previous urinary tract surgery or kidney and bladder stones.

For women experiencing recurrent infections, the aim is not simply to prescribe repeated courses of antibiotics. It is important to understand why the infections are occurring and how they can be prevented.

Depending on the individual, prevention may involve vaginal oestrogen, Hiprex, post-coital antibiotics or longer-term low-dose antibiotic prophylaxis.

When should I see a doctor?

You should seek medical assessment if you have symptoms of a UTI, particularly if infections are recurring.

Seek urgent medical attention if urinary symptoms are associated with:

• fever or chills

• pain in the back or side

• vomiting

• feeling significantly unwell

• visible blood in the urine

• difficulty passing urine.

These symptoms may indicate that an infection has travelled from the bladder to the kidney or that another condition requires urgent assessment.

The bottom line

UTIs are common throughout a woman's life, but the reasons they occur can change with age.

Before menopause, sexual activity and other factors are common contributors. Around and after menopause, reduced oestrogen can increase the risk of recurrent infections.

For women with recurrent UTIs, there are several effective prevention strategies. These include vaginal oestrogen, Hiprex, post-coital antibiotics and low-dose antibiotic prophylaxis.

The best approach depends on your age, menopausal status, triggers, previous urine cultures, other medical conditions and personal preferences.

This information is intended as a general guide and does not replace individual medical assessment.