a program of Morningside Ministries

Bladder Infections (UTIs) in Women after Menopause Christopher W. Graham, MD Urology San Antonio

The Problem

•  Onset: About 5 years after menopause or stopping estrogens •  UTI’s occur more frequently. •  UTI’s more common after sex

The Cause

•  Estrogens support vaginal health • Help good bacteria (lactobacillus) grow in the vagina, • Stops intestinal bacterial growth in the vagina

•  With menopause, vagina suffers • Intestinal bacteria replace lactobacillus • These bacteria more easily enter the bladder

The Solution

•  Symptomatic infections should be treated •  Occasional infections can be treated when they occur •  Frequent infections should be treated with prevention

Asymptomatic Bacteriuria

•  Bacteriuria without symptoms should not be treated

•  Fictitious bacteriuria common with contamination in vagina

•  Constitutional symptoms may be the only symptoms of a UTI

Restoring Vaginal Health •  Cleaner is not better. Vaginal washes, douches, and soap vaginally kill lactobacillus. •  Probiotics to restore lactobacillus growth vaginally

•  Oral probiotics show marginal benefit •  Vaginal probiotics have limited data

•  Vaginal suppositories •  Finger application of powder from probiotic capsule

•  Vaginal moisturizers •  Reduce discomfort of vaginal atophy •  May not have a benefit for reducing infections.

Vaginal Estrogens: Benefits

•  Estrogens help the good lactobacillus grow normally •  Estrogens improve vaginal function, including sexual function

Vaginal Estrogens: Risks

•  Estrogens absorbed vaginally, but often lower blood levels than with systemic estrogens. •  Estrogen +/- progesterone risks

•  Breast cancer •  Uterine cancer •  DVT and other cardiovascular risks

Prophylactic Antibiotics

• Daily antibiotic • Post-coital dosing • PRN dosing when symptoms develop