Why do I keep getting cystitis in my 40s?

What is cystitis?

Cystitis is a urinary tract infection (UTI). It affects the tube that carries urine out of your body, called the urethra. Sometimes, it can also affect your bladder (1).

The term "UTI" refers to different urinary infections. It specifically means an infection in any part of the urinary tract. This includes the kidneys and urethra.

Women tend to get cystitis or UTIs more often than men. Cystitis can get better by itself, but other treatments, like antibiotics, are sometimes needed.

Familiar symptoms usually include the urge to urinate (wee) more, discoloured or smelly urine (wee), and tummy pain when you go to the loo.

Why can you get cystitis more often when you're older?

As women approach their 40s, they can enter peri-menopause (the transitional stage before menopause) or menopause itself. Both peri-menopause and menopause cause a drop in oestrogen.

This makes the lining of the urethra and bladder thinner, making them more vulnerable to bacteria.

This is also known as "Urogenital Atrophy" and can lead to a higher risk of a UTI or cystitis.

Your usual GP should discuss a vaginal oestrogen cream or pessary to prevent recurrent cystitis or UTIs if you are approaching or have already been through menopause (1).

You can also request treatment from our independent online doctor, who may start you on a course and allow you to follow up with your usual GP after a few weeks.

What qualifies as "recurrent" cystitis?

NHS guidelines consider a person to have recurrent cystitis or UTIs if they have had three or more infections over the past year or more than two in six months.

If this feels relevant to you, read more.

Can peri-menopause or menopause cause cystitis?

Yes, it can for some women. As oestrogen levels drop during peri-menopause and menopause, the variety of protective bacteria in this area also decreases.

This flora imbalance makes a woman more likely to get cystitis or a UTI. You can prevent cystitis and UTIs in several ways. There are also specific methods to help if they are linked to peri-menopause or menopause in your 40s.

How can I prevent cystitis during peri-menopause or menopause?

There are several ways to prevent cystitis or a UTI, including;

• Washing: gently wash your genital area with water, particularly before sex. Avoid harsh soaps and washing internally. The tissues of the vagina can otherwise become easily irritated, and you might wash away the internal good bacteria that do an excellent job of keeping harmful bacteria at bay (2)
• Going to the loo: particularly before and just after sex. This helps to flush out and clear any harmful bacteria from your bladder and urethra (2)
• Drinking plenty: staying hydrated will also help flush harmful bacteria from your urinary system. Aim for at least 6 to 8 cups or glasses of fluids per day (3)
• Complete bladder emptying: Take your time to empty your bladder fully, especially before and after sex. If you aren't sure if your bladder is empty after urinating, wait 10 seconds and then try again to make sure (4)
• Lifestyle: Some evidence suggests that probiotics, cranberry products, and D-m mannose may help prevent infections. You can buy these over the counter. In general, though, try to aim for a healthy and balanced diet, good hydration, and exercise (3)

Specifically for peri-menopausal or menopausal women, if you have already tried the self-care advice listed above, there is a chance your cystitis is linked to your oestrogen levels declining.

Vaginal oestrogens are a type of Hormonal Replacement Therapy, or HRT, which can also help to prevent cystitis and UTIs during peri-menopause or menopause.

Oestrogen helps by boosting the production of antimicrobial substances in bladder and vaginal cells. This can improve immunity and lower the risk of infections.

Using vaginal oestrogen to restore the balance of natural good bacteria may significantly reduce your risk of having cystitis or a UTI (4).

What about the antibiotic treatments for cystitis?

Your GP may offer a urine test, some self-care advice, or a prescription for antibiotics. As most infections resolve themselves, sometimes you may be advised to wait 48 hours before starting antibiotics to give the symptoms a chance to go away on their own (1).

If you require antibiotics, learn more about how Oxford Online Pharmacy can support you.

However, if you have tried several courses of antibiotics in the past, you may want to try a course of vaginal oestrogen to see if this reduces the number of times you get cystitis or a UTI.

What "vaginal oestrogens" are available, and how do I get them?

If you've been to your GP and had courses of antibiotics in the past, but you haven't had any treatments yet to rule out the menopausal link. They might offer you a vaginal oestrogen preparation to prevent UTIs or cystitis (5).

The good news is that vaginal oestrogens are available on a private prescription through Oxford Online Pharmacy. They are available in cream, gel, or pessary form.

Examples of brands include Vagifem, Estriol cream and Blissel. To learn more about vaginal oestrogens and understand the different types, see our specialist vaginal oestrogen article.

What should I do if I try a vaginal oestrogen prescription but I'm still getting cystitis or UTIs?

After trying a vaginal oestrogen preparation, if you are continuing to have more than 2 UTI infections over 6 months, or three or more per year, you should see your GP for follow-up.

It is advised you ask for an urgent GP appointment or get help from NHS 111 if you think you have cystitis and:

• A very high temperature or feeling hot and shivery
• A low temperature, or shaking and shivering
• Pain in the lower tummy or the back, just under the ribs
• Are confused, drowsy or have difficulty speaking
• Are feeling or being sick
• Have not had a pee all day
• Blood in your pee

These symptoms could mean you have a kidney infection, which can be serious if not treated as it can lead to sepsis (1).

References:

1. NHS . Cystitis [Internet]. NHS. 2019.
2. Dr. Lucy Wilkinson. Complete guide to sex and UTIs during menopause [Internet]. Stella. 2022.
3. NHS. Water, Drinks and your Health [Internet]. nhs.uk. 2023.
4. Urinary Tract Infections (UTI) [Internet]. The Urology Foundation.
5. About vaginal oestrogen [Internet] nhs.uk. 2023.