Urinary Tract Infections

Recurrent Urinary Tract Infection Q&A

menopause | perimenopause

What is recurrent UTI?

Recurrent UTI is defined as three or more UTIs within 12 months, or two or more occurrences within six months. Symptoms are painful urination (dysuria), increased frequency of urination, and urinary hesitancy (difficulty starting the stream).

What causes recurrent UTI?

In premenopausal women, the following are risk factors for recurrent UTIs:

  • sexual intercourse three or more times per week
  • spermicide use
  • new or multiple sex partners
  • having a UTI before 15 years of age.

In postmenopausal women, the main contributing factor to recurrent UTI is lower estrogen levels.

What treatments are available?

menopause | perimenopause

Many patients try long-term use of antibiotics to prevent UTI. While longer-term use of antibiotics does decrease the recurrence of infections, it also increases the risk of antibiotic resistance - which can lead to the development of "superinfections" that can not be treated. There is also some newer research that is exploring a possible link between increased use of antibiotics, particularly penicillin and nitrofurantoin (Macrobid), and increased incidence of breast cancer.

There is good evidence for the use of D-mannose, an over-the-counter supplement, 500mg taken once daily to prevent UTI. D-mannose can also be taken at the first sign of a UTI.  D-mannose is a sugar that is found in many fruits, and its mechanism of action is that it inhibits bacterial colonization of the urethra. Diabetic women and women with insulin resistance should use caution with long-term use of D-mannose. D-mannose is safe for non-diabetic pregnant and lactating women.

For postmenopausal women with atrophic vaginitis and recurrent UTI, topical estrogen therapy is a first-line treatment to prevent UTI recurrence. Topical estrogen therapy, together with pelvic floor physical therapy, can be an effective treatment to reduce UTI reoccurrence for many post-menopausal women.