Why are UTIs more common around menopause?

A guest blog authored by Dr Shilpa McQuillan

If you’ve started noticing more urinary tract infections (UTIs) during perimenopause or menopause, you’re not imagining it and you’re definitely not alone. Many women find it confusing that they get more infections at this stage of life. The truth is, there are clear biological reasons for it most of them linked to oestrogen, the vaginal and urinary tract microbiota, and subtle changes in bladder health.

Why do hormones affect your Urinary Tract

Oestrogen does far more than support your menstrual cycle. It plays a key role in maintaining the health of the bladder, urethra, and vaginal tissues all parts of what’s called the urogenital tract. Around perimenopause and menopause, oestrogen levels start to fluctuate and eventually decline. This drop affects several important systems at once:

Loss of oestrogen receptors in the Bladder and Urethra

These tissues contain oestrogen receptors that help maintain elasticity, collagen, and glycogen. When oestrogen falls, the tissue becomes thinner, less elastic, and less well supported. This means the bladder may not empty as efficiently, leading to urine stagnation a perfect breeding ground for bacteria. The urethra also loses its natural folds (rugae) that help it contract and relax properly. This makes it easier for bacteria to travel upwards and cause infection.

Loss of oestrogen in the Vulva and Vagina

Oestrogen decline also affects the vulva and vaginal tissues. With less elastin and collagen, skin integrity and thickness are reduced, and moisture levels drop. This makes the tissues thinner, drier, and more fragile - a weaker barrier that is easier for bacteria to penetrate. Because the vulva and vagina close to the urinary tract, these changes increase the likelihood of bacteria ascending from the vagina to the urethra and bladder, and recurrent UTIs.

Reduced vaginal Glycogen and Microbiota disruption

Glycogen acts as the “food source” for beneficial bacteria (mainly Lactobacilli) in both the vagina and urinary tract. When oestrogen levels fall, glycogen production drops, leading to a decline in Lactobacilli and a rise in vaginal pH. Normally, low pH helps maintain Lactobacilli, and conversely, Lactobacilli keep the vaginal pH low - a protective cycle that wards off harmful bacteria. When this balance is disrupted, pathogenic bacteria can thrive and multiply, increasing the risk of both vaginal and recurrent UTIs.

The Gut-Vagina-Bladder connection during perimenopause

You’ve probably heard of the gut microbiota but your vaginal and urinary tract microbiota are just as important. Both are deeply connected and influenced by what you eat, drink, and how your body is changing during perimenopause.

• Sweats and dehydration Hot flushes and night sweats can leave you dehydrated. This concentrates urine, irritates the bladder lining, and slows flushing of bacteria, making it easier for harmful bacteria to take hold.
• Diet choices Perimenopause can leave you feeling tired, flat, or lacking motivation and it’s easy to turn to quick or comforting foods and drinks that are higher in sugar or processed foods. But these can shift vaginal and urinary pH, reducing those helpful Lactobacilli and allowing more “bad” bacteria to grow, which can increase the risk of UTIs. Alcohol and caffeine also play a big role. You might find yourself drinking more caffeine to combat perimenopausal insomnia or reaching for a glass of wine to unwind. Both are diuretics, which make you urinate more often, and they can irritate the bladder lining, disrupting the delicate microbiota balance and aggravating urinary symptoms.
• Weight changes Many women notice weight gain around this time. Increased abdominal fat and insulin resistance can affect metabolism, inflammation and vaginal pH disrupting the balance of healthy bacteria and making thrush and urinary infections more likely.

What can you do to support yourself

Spotting the hormonal pattern
You might notice that your UTI symptoms come and go with your cycle, or flare up around certain hormonal shifts. Tracking when your symptoms appear can help identify a cyclical pattern, giving your healthcare provider valuable clues about what’s really happening. Some women find that using continuous contraceptive pills or Hormone Replacement Therapy (HRT) helps stabilise hormone levels and reduce those ups and downs that can trigger urinary or vaginal symptoms.

Supporting your microbiome
Staying hydrated, prioritising fibre-rich foods, limiting processed sugars and irritants, and including fermented foods (like kefir, live yoghurt, kimchi, and sauerkraut) can all help restore a healthier microbiota and support urinary and vaginal health. Probiotics are another key tool, particularly those containing Lactobacillus strains, which can help maintain a healthy microbiota and reduce the risk of infections. 

Evidence suggests that taking targeted, evidence-based probiotic supplements, containing the right strains and in sufficient quantities, can support both vaginal and urinary tract health, complementing the benefits of a balanced diet. However, be mindful of marketing claims - not all probiotics are created equal. Their effectiveness depends on clinically proven strains, appropriate dosing, and formulations that avoid unnecessary fillers or bulking ingredients.

Use topical urogenital oestrogen
For many women, topical oestrogen therapy in the form of creams, pessaries, or vaginal tablets can be a game-changer. Applied directly to the vulva, vagina, and urethra, it helps restore local oestrogen levels, rebuild tissue strength, support Lactobacilli growth, maintain a healthy vaginal pH, and relieve common bladder symptoms such as poor emptying, frequent urges, and recurrent UTIs.

When to seek specialist help
If you’ve tried lifestyle adjustments, microbiome support, and hormonal strategies but are still experiencing recurrent infections, don’t give up. Long-term improvement is often seen with a combination of lifestyle changes, hormonal support, and targeted medical treatments.

It’s also important to avoid self-diagnosing or self-medicating. Many other conditions can mimic UTI symptoms, and getting the right diagnosis ensures you receive the safest and most effective care. A specialist can help identify whether hormonal support, microbiota repair, or structural changes are driving your symptoms and tailor a plan specifically for you. Remember, you don’t have to navigate this alone - we are here to help.

About the author

Dr Shilpa McQuillan leads the Berkshire Menopause Clinic and is a British Menopause Society Menopause specialist, community gynaecologist and women’s health GP. For more information, visit www.berkshiremenopauseclinic.com.