Menopause Cystitis and UTIs: Why They Happen and Help

It starts with a sting or a burn when you pee. Then you need to go again a few minutes later, and only a little comes out. There may be a dull ache low in your tummy. And if it keeps happening since your periods changed or stopped, you may wonder if menopause and cystitis are linked.

They can be. The NHS says you may get more urinary tract infections (UTIs) around the menopause, or symptoms that feel like one. Cystitis means an infection of the bladder. It's one kind of UTI, so menopause cystitis and a UTI in menopause are often the same thing.

This page explains why a UTI in menopause and perimenopause is more likely, and what can help.

Ask for an urgent GP appointment or get help from NHS 111 if you have UTI symptoms and:

a very high temperature, or you feel hot, cold or shivery
a very low temperature, below 36C
pain in your lower back or side, or in your back just under the ribs
you're feeling or being sick
blood in your pee
you're 65 or over, or you have diabetes or a weakened immune system
your symptoms get worse quickly, or aren't better within 48 hours

Call 999 or go to A&E if you:

are confused, drowsy or have trouble speaking
are breathing very fast, have blue, pale or blotchy skin, or a rash that doesn't fade when you press it. These can be signs of sepsis

The NHS says back pain with a UTI can be a sign of a kidney infection, which can lead to sepsis if it isn't treated. Don't drive yourself to A&E.

About this page: it's based on NHS guidance, including the NHS page on UTIs and the NHS page on kidney infection. It hasn't been reviewed by a doctor, and it can't tell you what's causing your symptoms. If you're worried, speak to your GP or call NHS 111. In an emergency, call 999.

Menopause cystitis: why are UTIs more common after menopause?

The NHS says UTIs are usually caused by bacteria from the bowel getting into the urinary tract. Women have a shorter urethra (the tube you pee through), so bacteria reach the bladder more easily. The NHS lists the menopause among the things that make a UTI more likely.

Women's Health Concern, the patient arm of the British Menopause Society, says UTIs can affect women of any age, but they get more common with age because of lower oestrogen.

Falling oestrogen changes the vagina too. Women's Health Concern explains that without oestrogen, the vagina becomes less acidic. That upsets the balance of germs that normally live there, and lowers the "good" bacteria, called lactobacilli. A 2020 review describes the same changes, and lists UTIs that keep coming back as one of the urinary symptoms of genitourinary syndrome of menopause (GSM).

Our page on vaginal dryness in menopause explains GSM.

Can perimenopause cause UTIs?

It can. The NHS lists more UTIs among the symptoms of perimenopause and menopause, not only after your periods have stopped.

It also says you may get symptoms that feel like a UTI. That's because the bladder is affected by lower oestrogen too. Women's Health Concern says many women notice needing to pee more often, waking at night to pee, or a sudden urge to go. Not every sting or rush to the loo is an infection, which is why a check can help if it keeps happening.

Symptoms of cystitis and UTIs

The NHS lists these symptoms:

pain or burning when you pee
needing to pee more often than usual, including at night
needing to pee suddenly or more urgently
cloudy pee, or blood in your pee
pain low in your tummy, or in your back just under the ribs
a high temperature, or feeling hot and shivery
feeling tired or weak

Dark or smelly pee on its own may simply mean you haven't drunk enough.

The NHS says older or frail people may show different signs. These include confusion or agitation, leaking more than usual, or new shivering.

Can a pharmacy help with a UTI?

Yes, often. The NHS says to see a pharmacist if you think you have a UTI and you're a woman aged 16 to 64 who isn't pregnant or breastfeeding. A pharmacist can supply the same medicines as a GP.

The NHS calls this Pharmacy First. You don't need to see a GP or make an appointment. Most pharmacies offer it, but the NHS suggests contacting them first to check.

If you're 65 or over, the NHS says to ask for an urgent GP appointment or use NHS 111 instead.

What a GP may do

The NHS says a GP may:

test your pee, though this isn't always needed
suggest self-care and a painkiller
prescribe a short course of antibiotics
suggest waiting 48 hours to see if it clears up by itself

If you're given antibiotics, the NHS says to finish the course, even if you feel better.

Self-care while you get better

The NHS suggests:

taking paracetamol for pain and a high temperature
resting
drinking enough so your pee is pale
avoiding drinks that can irritate the bladder, such as coffee, alcohol and fruit juice

The NHS also says there's no evidence that cystitis sachets or cranberry drinks ease symptoms once an infection has started.

How to lower your chances of another UTI

The NHS suggests:

Do	Try not to
wipe from front to back	use scented soap on your genitals
keep the area clean and dry	hold your pee in
drink plenty of fluids	rush when you pee
wash around the vagina before and after sex	wear tight underwear
pee as soon as you can after sex	drink a lot of alcohol or sugary drinks
change pads promptly if you leak	use spermicidal lubricant or other products with spermicide
wear cotton underwear

Recurrent UTIs after menopause

The NHS says to see a GP if you get UTIs often. That means 2 in 6 months, or 3 in 12 months.

Your GP may talk to you about:

a different antibiotic
a low-dose antibiotic for up to 6 months
a medicine to help stop UTIs coming back
a referral to a specialist
vaginal oestrogen, if you're in perimenopause or menopause, or past it

Vaginal oestrogen for recurrent UTIs

Vaginal oestrogen is a low-dose hormone treatment that you put inside the vagina. It comes as a cream, gel, tablet, pessary or ring.

NICE, which writes guidance for the NHS, says doctors should consider it for recurrent UTIs in women around or after menopause, if self-care steps alone haven't worked. NICE says serious side effects are very rare. Only a tiny amount is absorbed into the bloodstream. It may help other symptoms too, such as vaginal dryness. NICE says treatment should be reviewed within 12 months.

Women's Health Concern says vaginal oestrogen has been shown to reduce urine infections. NICE also says HRT for the whole body (the usual kind of HRT) shouldn't be offered just to lower the risk of UTIs.

If you've had breast cancer, talk to your GP or breast cancer team first. NICE's menopause guidance has separate advice for you.

If vaginal oestrogen isn't right or doesn't help, NICE describes other options. One is a single dose of antibiotic to take after a known trigger. Bladder Health UK gives sex as an example. Another is a non-antibiotic medicine called methenamine hippurate.

What about cranberry and D-mannose?

The NHS says there's some evidence that taking D-mannose or cranberry products every day may help stop bladder infections coming back. It says both can be high in sugar, and that people taking warfarin should avoid cranberry products.

NICE says the evidence for cranberry is uncertain, and there's no evidence it helps older women. It describes D-mannose as a sugar, not a medicine.

If you're thinking about either, ask your GP or pharmacist first, especially if you take other medicines.

Chronic UTIs: when symptoms don't go away

Sometimes symptoms carry on, but urine tests don't find an infection. The NHS says this may be a long-term (chronic) UTI. If your symptoms continue, you can ask your GP about seeing a specialist.

Menopause and interstitial cystitis (bladder pain syndrome)

Bladder pain syndrome is also called interstitial cystitis. The NHS says it's a long-term condition. It causes pain in the bladder, lower tummy or back, and a strong need to pee, even when the bladder is empty. Sex can be painful too.

The NHS says it's more common in women and usually affects people aged 40 or over. The cause isn't clear. There's no single test, so doctors first rule out other causes, such as a UTI.

There's no cure, but the NHS says treatments can help manage it. They include medicines, pelvic floor physiotherapy and bladder retraining. It suggests keeping a food and drink diary to spot triggers. The NHS suggests cutting down on caffeine, alcohol, and spicy or acidic food.

Bladder Health UK, a UK charity, has advice on cystitis and runs a confidential helpline.

When to see a GP

See your GP if:

you're 65 or over and think you have a UTI
you get 2 UTIs in 6 months, or 3 in 12 months
your symptoms aren't better within 48 hours, or are getting worse
symptoms carry on after treatment, or keep coming back when tests are clear
you have bladder, tummy or back pain that won't go away
you're leaking urine. See our page on menopause incontinence

UTIs often go with vaginal dryness in menopause, menopause discharge and menopause incontinence. If sex is sore too, see painful sex after menopause. You can see them all in our list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms

Menopause cystitis and UTIs: why they're more common, and what helps