As hormones change with the stages of the menopause, reoccurring episodes of cystitis can unfortunately become very common. The shift in the balance of hormones means women are much more likely to experience bladder irritations, vaginal dryness, painful intercourse and chronic urinary tract infections (UTIs), all giving symptoms of cystitis.
 
Most women will experience a bladder infection at some point, and the frequency increases with age. Studies have shown that around one-third of women experience recurrent urine infections and incontinence thanks to the menopause.
 
Menopause as we know is associated with many symptoms, and cystitis falls into that category. But why does this happen? Here we take a look at the changes in the body, why the menopause results in more bouts of cystitis and the steps women can take to minimise cystitis risks and soothe symptoms.
 

Menopause and cystitis

Oestrogen: The urinary tract and its supporting tissues need oestrogen to remain healthy. As women go through the menopause oestrogen levels fall, making the urinary tract open to increased infections, ultimately causing bouts of cystitis.
 
Changes to the urinary tract structure: The urethra can become more delicate and prone to infection and can also shorten, making it even easier for bacteria to make its way into the bladder.
 
The tissues supporting the bladder and urethra may also weaken, resulting in the bladder not fully emptying when you go to the toilet. The urine left behind in the bladder can become prone to infection.
 
In the bedroom: Sex increases the risk of bladder infections and this risk increases at the time of the menopause. During this phase of a woman’s life, vaginal dryness and increased sensitivity can lead to cystitis.
 

A closer look at health 

Vaginal pH: Oestrogen has an impact on our vaginal pH. Before the menopause, both good and bad bacteria exist together in the vagina. Oestrogen allows the “good” bacteria (e.g., lactobacillus) to thrive. Lactobacillus produces acid, which lowers the vaginal ph. This ultimately keeps the “bad” bacteria in check.
 
When the ovaries no longer produce oestrogen, there are fewer good bacteria to fight off bad bacteria. Bad bacteria such as E. coli make their way from the rectum to the urethra, attaching to its wall and resulting in a urinary tract infection.
 
Stress incontinence: Over 40 per cent of menopausal women have urinary incontinence. This happens in menopausal women because, over time, the muscles of the pelvic floor (i.e., the muscles that support the bladder and rectum) become weak.
 
Oestrogen stimulates blood flow to the pelvic region, which strengthens pelvic floor muscles. When oestrogen decreases, these muscles become weak, and they lack the strength to keep the bladder closed.
 
In addition, prolonged use of moist, absorbent incontinence pads exposes the urethra directly to bacteria and increases the chance of a urinary tract infection.
 
Bladder prolapse: The front wall of the vagina keeps the bladder in place. Lack of oestrogen can also weaken the tissues of the vaginal wall, and the bladder can prolapse, or descend into the vagina.
This makes it more difficult to empty the bladder completely when urinating. When urine stays stagnant in the bladder, bacteria can multiply and cause cystitis.
 

A closer look at cystitis 

Cystitis is inflammation of the bladder and can be caused by a UTI. With it comes a set of unpleasant symptoms, which can begin with slight stinging in the urethra (the tube through which urine passes) when having a pee.
 
As cystitis develops, you experience pain and/or a sensation of burning when passing urine; you may pee more often or feel like you need to. You may try to urinate but only pass a few drops or feel some pain without passing any urine. The pain and burning is due to the lining of the bladder and urethra becoming red, inflamed and irritated. You may also feel achy at the bottom of your back or pelvic pain.

Cystitis can make you feel quite unwell and you may pass blood in your urine or experience a high temperature and fever.
 
Cystitis is 30 times more common in women as in men as women have a shorter urethra, and the opening is located very close to the anus. This makes it easier for bacteria present in the large bowel to reach the bladder and cause an infection.
 

Reducing the risk of cystitis during menopause

Some simple lifestyle choices will help to reduce the risk of cystitis at any point in life, including menopause. Here, Dr Catherine Hood from effercitrate.co.uk shares her tips.

H₂0 up: Have a large glass of water straight after having sex. It is important to drink a lot as this strengthens your pee stream and reduces the chances of bacteria sticking to the wall of your bladder and urinary tract. Effective hydration will generally make you pee more often, flushing bacteria out.

Diet: Eat a healthy, immune-boosting diet. It’s important to look after your immune system to reduce the risk of infection. Eat plenty of fruit and vegetables for B vitamins and vitamin C. Include nuts and seeds for vitamin E and selenium, and lean meat, fish and dairy for zinc; red meat and wholegrains for iron. Take the UK government recommended vitamin D supplement providing 10 micrograms daily.

Wash down below: Wash your genital area before and after sex. This helps to keep any bacteria away from the urethra.

Look after your gut: The health of your gut microbes can impact your immune function and risk of infection. A healthy diet with plenty of fruit and vegetables with minimal or no ultra-processed foods high in sugar, fat and salt may shift the balance of your gut microbes in a healthy direction. Also consider taking a probiotic supplement or a fermented food or drink such as live plain yoghurt or kefir.

Visit the toilet: Have a wee and empty your bladder after sex, including oral sex, and drink a large glass of water. Lean back on the toilet when passing urine and wait for the last few drops to pass out.

Get some relief:  If you do have cystitis, try Effercitrate Tablets which will provide fast, soothing relief from symptoms.

Go unperfumed: Avoid bubble baths, talcum powder and feminine wipes as these can cause irritation.

Wear cotton underwear: Opt for cotton underwear as it is soft and allows the vagina to ‘breathe.” Stay clear of tight-fitting jeans or trousers.

Stay dry: Keep your genital area dry from urine. If using liners due to leaks of urine, make sure to change them regularly.

Avoid sex (when you have cystitis): Sex can cause friction and irritation in the urethra, which is sensitive during an infection. With penetrative sex, pressure on the vagina can also put pressure on the bladder and cause more pain if it is inflamed and sensitive.

Consider HRT: A lack of oestrogen across menopause stages can make the lining of the urinary tract more susceptible to harmful bacteria. You may also have thinning and soreness of the tissue around the urethra, vulva and vagina. Consider HRT which replaces oestrogen and can improve the health of the genitourinary tissues which have been made thin and delicate by lack of oestrogen. This can also help to prevent urinary infections.

Seek medical advice: If symptoms of cystitis continue for more than a couple of days after treatment, see your GP–cystitis can occasionally progress to a kidney infection which will require treatment with antibiotics.