Menopause

The Etiology and Management of Recurrent Urinary Tract Infections in Postmenopausal Women

Jung, C., & Brubaker, L.

Menopause Society, 22(3), 242–249.

Keywords

Urinary microbiome, Urinary tract infection, Urobiome, Bladder, Bladder health

Abstract

Urinary tract infections (UTI) are one of the most common infections and affect up to 50% of women intheir lifetime, with almost half of these women experiencing a recurrence in 6–12 months. Menopause predisposes women to rUTI, as normally lower levels of estrogen lead to changes in the urogenitale pithelium and subsequently urogenital microbiome. The recently discovered urobiome is nowknown to have different compositions in both healthy and unhealthy bladders, including a role in the pathophysiology of rUTI, and may be a therapeutic target for prevention and treatment options for rUTI. In postmenopausal women with frequent UTI, the diagnosis of acute UTI should be made using a combination of the symptom assessment and urine diagnostic studies. The choice of UTI antibiotic should include consideration of efficacy, collateral effects, and side effects. Some women may be candidates for self-start therapy, in which the patient accurately recognizes her UTI symptoms and then starts previously prescribed antibiotics. A large component of the management of women with rUTI is prevention. Urobiome research for bladder health and disease is a young field of investigation with significant potential to improve care for postmenopausal women affected by rUTI through novel, evidence-based prevention and treatment strategies.