More than half of all women will experience a urinary tract infection (UTI) at some point in their lives.1 But identifying the problem, which can occur when bacteria enter the urethra, can sometimes be challenging.
Though the symptoms of a UTI are relatively easy to spot, they closely resemble other health conditions that can also occur in perimenopause and menopause, explains Peter Castillo, M.D. FACOG, FPMRS. Here's how to determine what you might be dealing with, whether you can count on the results of an at-home UTI test, and what to do if you find that you’re struggling with recurrent UTIs during menopause and beyond.
Common Urinary Changes During Menopause
Declining levels of estrogen during perimenopause and menopause can cause changes in a woman's vaginal pH, which can disrupt the balance of good and bad bacteria found in the vaginal microbiome. "This increase in bad bacteria can predispose women to UTIs," Dr. Castillo explains.
Hormonal shifts can also cause inherent changes to vaginal tissues and the urinary tract, leading to conditions like genitourinary syndrome of menopause (GSM), or the medical term encompassing vaginal dryness and its myriad of symptoms. GSM, too, can cause symptoms like pain or burning while urinating along with increased urgency, even without the presence of a UTI or other infection.2 Women dealing with GSM and its related symptoms can also be more prone to acquiring small cuts or microabrasions during sexual activity, putting them at greater risk for infection.
How Do I Know If It's A UTI During Menopause?
You may be familiar with the tell-tale signs of a UTI. But because UTI symptoms can mimic other conditions, it may not always be easy to tell what you're dealing with, according to Dr. Castillo.
You may be experiencing a UTI if you have:3
- Pain or burning while urinating.
- Frequent urges to urinate, but not much comes out.
- Pressure or pain in your lower abdomen or pelvis.
- Urine that smells bad or appears milky or cloudy.
- Blood in your urine.
- Fatigue, weakness, or confusion.
- A fever, which means the infection may have reached your kidneys.
Diagnosing a UTI: Can You Use an At-Home UTI Test?
You can't diagnose a UTI with 100% certainty based on symptoms alone. Instead, a urine culture is needed to confirm the presence of infection-causing bacteria.
If your healthcare provider suspects that you have a UTI, they'll have you provide a urine sample and test the urine for common forms of bacteria that cause a UTI. Be advised, getting the results can take a few days. Some providers will wait until the test results come back to prescribe antibiotics to clear the infection,4 while others may prescribe antibiotics proactively, especially if you have a history of frequent UTIs, Dr. Castillo says.
Testing your urine at home may also be an option, but not all at-home UTI tests are created equal. Over-the-counter dipsticks are a preliminary way to check for the presence of nitrites in the urine, which are typically produced by a UTI-causing bacteria. However, most at-home tests won't be able to identify which specific bacteria may be causing your symptoms, explains Dr. Castillo. More on those below.
A more advanced option for at-home testing is MyUTI, a PCR test that checks for the presence of multiple bacterial strains to pinpoint the specific cause of your infection. "Once you mail out your sample and the lab receives it, you'll get your results in 24 hours with detailed findings about the organism that's causing the infection and the recommended antibiotic therapy," Dr. Castillo says. You can then bring those findings to your healthcare provider, who can confirm the diagnosis and write an antibiotic prescription.
What About Stubborn or Recurrent UTIs During Menopause?
A woman is considered to have recurrent UTIs if she develops two or more infections per year. For some, recurrent UTIs are a lifelong nuisance. "Anatomic, immunologic, and genetic differences may make some women more prone," Dr. Castillo explains. But more commonly, hormone shifts can trigger frequent UTIs during perimenopause and beyond. In those cases, "it could be a loss of estrogen support that's predisposing them to infections by not supporting the good bacteria to survive and creating an environment that supports the bad bacteria," says Dr. Castillo.
Women who begin getting recurrent UTIs during perimenopause or menopause should be evaluated by their healthcare providers, Dr. Castillo advises. Your provider can determine whether your symptoms are being driven by an infection or another problem, such as atrophy, the term used to describe vaginal changes that can lead to vaginal dryness or its related symptoms, and can decide on appropriate treatment measures to make your symptoms more manageable, from there.
What Can Present Like A UTI But Isn't?
It's easy to assume that a UTI is the culprit when you're experiencing pain with urination, burning, or an increased frequency of urination. But "there are other conditions that can cause the same symptoms that aren't related to a UTI," Dr. Castillo cautions.
Vaginal yeast infections are infections most commonly caused by an overgrowth of the fungus candida albicans. They're common, affecting 3 out of 4 women at some point in their lifetimes, but they’re not necessarily more likely to occur during perimenopause or menopause, unless a woman is using hormone therapy.
Yeast infections can cause vaginal itching, pain or burning during sex or urination, redness or swelling, and vaginal discharge that's white, thick and cottage cheese-like or thin and watery. These types of infections can be diagnosed with a pelvic exam and through testing vaginal secretions to determine if it's candida, and if it's not, it can help determine which strain is causing the infection. Antifungal medications are typically needed to clear the infection.
Sometimes called painful bladder syndrome, interstitial cystitis is a chronic condition that affects up to 8 million women in the U.S. It's marked by pelvic pain and increased urinary frequency as well as urgency that lasts longer than six weeks. Unlike UTIs, interstitial cystitis isn't caused by an infection. Instead, experts think it could be related to autoimmune conditions or allergies.
There's no single test to diagnose interstitial cystitis. Instead, your provider may rely on tissue biopsies, and bladder exams, such as a cystoscopy (endoscopy of the urinary bladder via the urethra). The condition can't be cured, but it can be managed with lifestyle changes like avoiding trigger foods, in addition to adding in exercise, physical therapy, and bladder retraining.
Ureaplasma is a type of bacteria often found in the urinary or genital tract. It can be spread through sexual contact but doesn't often cause symptoms. For some women, overgrowth of this bacteria can be associated with bacterial vaginosis, a vaginal infection that causes foul-smelling discharge, vaginal itching, and burning during urination.7
Your healthcare provider can determine whether you have bacterial vaginosis by conducting a pelvic exam and testing a sample of your vaginal fluids. This infection is typically treated with antibiotics.8
Mycoplasma is a bacterium that can cause infections in the lungs as well as the genital tract. An infection won't always cause symptoms, but it can lead to pain during sex or urination, vaginal discharge, and vaginal bleeding after sex.9
Both ureaplasma and mycoplasma are often missed as they are slow-growing bacteria that will not show up in routine urine cultures. Specialized testing is needed to identify this type of urogenital tract infection. The astute physician can diagnose ureaplasma and mycoplasma with specialized cultures of vaginal secretions that look for these bacteria, but may take more than a week to obtain results.
Alternatively, you can decide to self-test your urine by ordering the MyUTI test, which also detects this type of bacteria and can enable you to have results within 24 hours. Antibiotics will need to be prescribed to clear the infection.
When to Check In with your Healthcare Provider
If you’re experiencing more UTIs during perimenopause or menopause, or if this is your first UTI and you’re not sure what to do – a great first step is checking in with your healthcare provider. They can properly diagnose what may be going on and provide a recommended treatment.
If a UTI is detected, your provider can prescribe the appropriate antibiotic to address your infection; if vaginal dryness is a contributing factor, they can start you on a vaginal moisturizer or similar treatment. Rest assured, effective treatments are available for UTI and bladder discomfort(s), so be sure to consult with your provider to find the best solution for you.
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