During the menopause, our bodies undergo drastic hormonal shifts - but what you might not realise is that the summer months in particular introduce environmental factors that can make your discomfort even worse.
One of the most common, yet frequently overlooked, issues is cystitis: a urinary tract infection (UTI) that finds the perfect environment to thrive amidst the heat and hormonal changes.
While hormonal shifts are the foundation, Dr Miguel Ignacio López Ramiro, a GP and pharmacist specialising in microbiology, warns that there's a silent summer habit that's a primary trigger for the seasonal spike in women over 50.
The expert breaks down the role of oestrogen in cystitis, describes which menopausal UTI symptoms present differently than a "classic" case and highlights the specific habit that could be leaving you vulnerable as the temperatures heat up.
The summer mistake you don't want to make
© Getty ImagesMany women in menopause make one simple but critical error during the warmer months: inadequate hydration. Low fluid intake is a primary driver for summer UTIs, because the flushing mechanism of our bodies is more important than ever. "Keeping up an adequate fluid intake increases the frequency of urination, helping to flush bacteria out of the urinary tract before an infection can take hold," he says.
The expert outlines other common summer habits, in addition to dehydration, that "inadvertently encourage UTIs":
- "Holding it in" for long periods.
- Frequent use of vaginal douches or fragranced intimate products.
- Wearing synthetic underwear.
- Inadequate hygiene, such as wiping from back to front.
"These actions can help upset the natural balance of the vaginal microbiome, allowing bacteria to take hold in the urethra more easily," he notes.
Menopause and the perfect storm for infection
The hormonal changes that occur to women during menopause create a perfect storm for the development of urinary tract infections because the balance of the body's microorganisms is "disrupted", explains the GP.
"Specifically, the drop in oestrogen levels causes changes in the urogenital epithelium - the inner lining of the urinary and genital tracts - and, subsequently, in the urogenital microbiome," he says. "Vaginal pH increases, and levels of lactobacilli, which is the 'good' bacteria that protect against external germs, go down. This makes it much easier for gut bacteria to colonise the intimate area."
"During menopause, the alteration of the microbiome is primarily due to the fall in oestrogen. This compromises the body's natural defences, increasing the risk of recurrent UTIs, as well as dysuria (pain or stinging when urinating) and urinary urgency"
That dynamic then encourages urinary tract infections. "By increasing the diversity of bacteria in the urinary microbiome and decreasing the percentage of protective lactobacilli, it becomes easier for gut bacteria to colonise the area, often leading to recurrent cystitis. Specifically, there is a greater vulnerability to bacteria such as E. coli, a common cause of UTIs, so the risk of infection increases significantly."
UTI symptoms that look different in your 50s and 60s
According to Dr López Ramiro, the "classic indicators of a urinary tract infection" include "pain when urinating (dysuria), needing to pee more often, and the sensation that your bladder hasn't fully emptied. But in postmenopausal women, symptoms can sometimes be less typical."
Additional symptoms to look out for are:
- Incontinence
- Blood in the urine
- Suprapubic pain (pain in the lower abdomen)
"If you notice these symptoms, you should consult your doctor as soon as possible," advises the doctor.
The path to prevention
Along with drinking plenty of fluids, there are some other non-medicinal strategies the doctor recommends for women to help avoid getting a UTI.
© Getty Images"Taking cranberry supplements or drinking cranberry juice has been shown to help prevent recurrent UTIs," he notes. "Probiotics can also be beneficial, because they help maintain a healthy balance of bacteria in the urinary tract, boosting the body's natural defences against infection." He later adds: "Specific strains [of probiotics] have proven to be particularly effective, such as Saccharomyces boulardii and Lactobacillus acidophilus."
There's also a hormonal solution that may help. "There is a very close link between urogenital atrophy (thinning of the tissues caused by the drop in oestrogen during menopause) and recurrent UTIs," explains the doctor. "Because of this, low-dose vaginal oestrogen can play a key role in prevention."
