Pain and pressure in your lower belly, an urgent or constant need to pee, burning when you urinate, and cloudy or foul-smelling urine are strong indications that you’ve got a urinary tract infection (UTI), typically a bladder infection known as cystitis that is common in women. If you thought that your UTI days were over, you may be frustrated to find that they actually rise again after menopause. Over 10 percent of women over 65, and up to 30 percent of those over 85 said they’d had a UTI in the past 12 months, according to statistics reported in an Aging Health paper on UTIs in older adults. (In some older women, sudden symptoms like confusion and agitation that look like dementia might actually be a UTI.)
Postmenopausal women are especially susceptible to UTIs because of the physical changes that accompany aging. The urethra—the tube through which urine leaves the body—gets shorter as estrogen levels drop, and the urethral sphincter in the bladder neck gets weaker. This allows more bacteria like E. coli to colonize the perineum (the thin layer of skin between the vaginal opening and anus) and get into the bladder. Chronic conditions like diabetes, which also become more common with age, make it more difficult for the immune system to fight infection.
UTIs can sometimes lead to dangerous complications like kidney damage and sepsis, so it’s important to get diagnosed and treated quickly. Start with a visit to your primary care doctor or gynecologist.
Is it really a UTI?
Because conditions like an overactive bladder, a sexually transmitted infection (STI), kidney stones, and bladder cancer can mimic a UTI, your doctor needs to first confirm that a urinary tract infection is the actual cause of your symptoms. A urinalysis can do this by checking your urine for signs of infection (for example, the presence of numerous white blood cells).
But this test can be misleading because it’s not uncommon for a urinalysis to show the presence of bacteria. Usually, only if another test called a urine culture shows a significant amount of bacteria and you have symptoms would you need to be treated. The culture will reveal which type of bacteria is causing the infection.
For recurrent UTIs, your doctor might order an imaging test such as an ultrasound to determine whether you are fully emptying your bladder—since people who can’t are more likely to have recurrent UTIs—or to check for kidney or bladder stones or other abnormalities in the urinary tract.
The best treatment … remains antibiotics
Antibiotics have long been the foundation of treatment, and that’s still true today. If you have UTI symptoms, you probably need them. Drinking extra water or cranberry juice won’t usually be enough to rid you of the infection (but they might help ward off future infections; see below).
Which antibiotic you take and how long you stay on it depends on the type of infection you have. Most women have simple UTIs, which means their urinary tract is otherwise generally healthy. A short course (e.g., three days) of antibiotics should be enough to clear up the infection.
Complicated UTIs happen because of abnormalities in the urinary tract, or when the usual antibiotics aren’t effective against the bacteria causing the infection. These infections may require a longer course of treatment.
Narrow-spectrum antibiotics like nitrofurantoin (Macrodantin, Macrobid) or trimethoprim/sulfamethoxazole (Bactrim, Septra) are the preferred way to treat a UTI. They’re less likely to cause antibiotic resistance than broad-spectrum antibiotics.
If you’re treated with antibiotics, it’s important to finish the entire dose, even if your symptoms clear up sooner. The infection could return if you stop taking the medicine prematurely.
Warding off future infections
Once you’ve had a UTI, more of them could be in your future. Up to 40 percent of women will have another one. Recurrent UTI is the medical term for having more than two of these infections within six months or three or more infections in a year. You’re at higher risk for recurrent UTIs if you have urinary incontinence, a prolapsed bladder, diabetes, a history of UTIs before menopause, or difficulty fully emptying your bladder.
The following medicines and home remedies have varying degrees of evidence to back them. If you have recurring UTIs, it’s a good idea to discuss with your doctor which ones might be worth trying:
- Vaginal estrogen. The loss of estrogen after menopause causes a drop in lactobacilli, a type of bacterium that helps block the growth of harmful bacteria in the vagina and perineum that cause UTIs. Vaginal estrogen is generally considered safe, and it may reduce the risk of recurrent UTIs in postmenopausal women by 50 to 90 percent.
- Antibiotics. Taking a low-dose of an antibiotic like ciprofloxacin, nitrofurantoin, or trimethoprim/sulfamethoxazole daily or a single dose after sex is another way to prevent repeat urinary tract infections. This is a strategy you should discuss with a urologist or infectious diseases physician.
- Methenamine hippurate. This medication, which has been in use since the late 1960s, releases the chemical formaldehyde into urine to stop bacteria from growing. Methenamine hippurate is an alternative to antibiotics, and it often works just as well at preventing recurrent UTIs.
- Cranberry. There’s evidence that drinking 100 percent cranberry juice or taking cranberry capsules or powder (containing plant compounds called proanthocyanidins) is beneficial for reducing the risk of UTIs in some women who have repeated infections. Because there’s less evidence of a benefit in older women, however, and because cranberry juice can both irritate the bladder and interact with some medications, ask your doctor before using it to prevent UTIs.
- Water. A clinical trial in JAMA Internal Medicine in 2018 found that women with recurrent UTIs who increased their daily water intake by about 1.5 liters (around 6 cups) had fewer infections over the following year. Later reviews and analyses support the idea that drinking more water is a safe, low-risk way to help prevent future infections, though more research is needed in different groups and over longer periods. Drinking plenty of water has other perks, too, like keeping you hydrated and helping prevent constipation, which can make it harder to fully empty your bladder.
- D-mannose. This sugar, which is found in fruits, is marketed as a dietary supplement for preventing UTIs. D-mannose theoretically could prevent E. coli and other bacteria from sticking to the urinary tract, but the available evidence is not sufficient to confirm that it works. A randomized placebo-controlled trial of nearly 600 women in the UK with UTIs, published in JAMA Internal Medicine in 2024, found that daily use of d-mannose did not reduce UTI recurrence.
- Probiotics. The “beneficial” bacteria found in these supplements, when given orally, are promoted to help restore a healthier balance of microorganisms in your body. However, there is little good science to support their use for preventing UTIs.
BOTTOM LINE: Urinary tract infections become increasingly common as women go through menopause and their estrogen levels decline. Symptoms like an urgent need to urinate or pain/burning when urinating are typical signs of a UTI. Getting diagnosed and treated with antibiotics can help you avoid complications and recover more quickly. If you tend to get a lot of UTIs, talk to your doctor about strategies to prevent future infections.
