One of the first things a woman may notice as her hormonal balance changes is the recurrence of cystitis symptoms, such as urinary tract infections (UTIs) and painful sex. Cystitis is traditionally, and perhaps ironically, the sign of a good and happy honeymoon. However, for many women entering the menopause, a recurrence of these uncomfortable symptoms is distressing. Before it becomes a cause for worry most women seek medical advice from their GP and are usually prescribed antibiotics. A urine sample is sent off for further assessment as a precautionary measure. This will either come back positive, most commonly indicating that there is an E. Coli infection, or, frustratingly for the patient, maybe inconclusive.
E Coli is a group of organisms that live in the gut and our perineal region. They are not a major issue on the outside of our bodies if we maintain personal hygiene. However, they can lead to an infection if they travel up the urinary tract or gain entry through micro-abrasions in the surface layer of our tissue in the perineal area. This tissue is also referred to as the mucosa or the wet surface of our vulva and vagina.
There is a high chance that women may find themselves trapped in a cycle of GP appointments, repeat urine checks and, very often, hospital referrals for cystoscopies. The latter are camera tests to further evaluate our urinary tracts all the way from where we pass urine to the bladder. Clearly, this can become a major cause for worry, especially because urinary tract infections can often make us feel rather unwell.
So why is this happening on a more regular basis when women reach their 40s? Why is it that older women get urinary tract infections more often than their younger counterparts even when they are not sexually active? The answer is in our hormonal balance and the drop in our estrogen levels. Estrogen has a major role in maintaining the integrity of our vaginal, vulval and bladder mucosa. In fact, it is key to maintaining healthy connective tissue anywhere in the body, be it your bones, hair, skin, ligaments, walls of blood vessels and so on. Estrogen helps maintain healthy collagen and elastin, both of which allow connective tissue to maintain its elasticity. Think of any type of dough you’ve carefully mixed together; when it is moist it stretches and when it is dry it crumbles and breaks.
When we are young, and we have good estrogen reserves, our bodies heal quickly. Hence, any frictional damage to the surface layer of mucosa be it through wiping or sex, repairs itself at an amazingly fast rate. As our levels of estrogen, and therefore the nutrient for natural healing and cell repair, decline, we are left with small tears and weak areas in our mucosa. These then become the entry points for those organisms that are harmless on the outside of our bodies, but not when found inside our tissue. This in turn leads to cystitis, which most commonly means that there is burning and discomfort while passing urine. Women may experience this with or without a confirmed urinary tract infection.
Fortunately, urinary tract infections respond well to antibiotics; however, they can be prevented by maintaining our vaginal health with topical estrogen supplementation, which a doctor can prescribe. There are various estrogen preparations and dosages that are licensed for long-term indefinite use and your doctor should be happy to help you choose the one most suited to your needs. They act locally and their benefit and mode of action is restricted to the vaginal region. Chemically they are broadly similar to what your body would have produced. In addition, it is an important part of our own personal hygiene routine and overall prevention strategy that we use lubricants for sex to reduce frictional damage and avoid soaps when washing our vaginal region.
As estrogen restores vaginal health any vaginal dryness reduces. Therefore painful sex and discomfort during gynaecological examinations such as smear tests, as well as cystitis, become distant memories.
If you are peri-menopausal and are experiencing any of the above symptoms please seek advice from your doctor as there are many options available to you, which will ensure you go into the menopause knowing how to deal with the possible effects of reducing estrogen levels.