Vaginal Dryness, Recurrent UTIs & the Oestrogen Link

Vaginal dryness and recurrent urinary symptoms are more common than many women realise, especially during perimenopause and after menopause.

They can feel embarrassing to talk about, but they are medical symptoms and they are often linked to falling oestrogen levels.

You are not alone

Genitourinary symptoms of menopause can affect the vagina, vulva, bladder and urinary tract.

Evidence suggests that up to 50% of postmenopausal women may experience symptoms of vaginal atrophy or genitourinary syndrome of menopause.

UTIs are also very common. More than 50% of women will experience at least one UTI in their lifetime, and around 26% may have a recurrence within 6 months after treatment. In women aged 55 and over, recurrence within 1 year has been reported in around 53%.

How does oestrogen affect vaginal and urinary health?

Oestrogen helps keep the vaginal and urinary tissues healthy, moisturised and more resilient.

When oestrogen levels fall, the tissues can become thinner, drier and more sensitive. This can lead to symptoms such as:

• Vaginal dryness
• Soreness, burning or itching
• Pain during sex
• Urinary urgency or frequency
• Burning when passing urine
• Recurrent UTI-like symptoms
• Repeated UTIs
• Low oestrogen can also affect the normal vaginal bacteria and pH balance, which may make some women more prone to irritation and infection.

Why recurrent UTIs may not just be incidental

If UTIs keep coming back during perimenopause or after menopause, it may not be simply due to hygiene, sex or drinking too little water.

For some women, falling oestrogen levels can make the urinary tract more vulnerable.

The NHS defines recurrent UTIs as 2 UTIs within 6 months or 3 UTIs within 12 months. If this applies to you, it is worth seeking advice rather than repeatedly self-treating.

Can vaginal oestrogen help?

Vaginal oestrogen may be helpful for women with vaginal dryness and genitourinary symptoms linked to menopause.

NICE recommends offering vaginal oestrogen for genitourinary symptoms of menopause in people with no personal history of breast cancer. NICE also advises that vaginal oestrogen can be considered for recurrent UTIs if behavioural and personal hygiene measures are not enough or are not appropriate.

Vaginal oestrogen works locally. Only a minimal amount is absorbed into the bloodstream compared with systemic HRT, and serious side effects are considered very rare.

It can come as a cream, gel, tablet, pessary or ring. Treatments such as Estriol 0.1% cream, Estriol 0.01% cream, Vagifem® vaginal tablets and Lenzetto spray are commonly prescribed to help relieve vaginal dryness and urinary symptoms associated with menopause. The best option depends on your symptoms, preferences, medical history and clinical suitability.

Is vaginal oestrogen the same as HRT?

Not exactly.

Vaginal oestrogen is a local treatment used mainly for vaginal and urinary symptoms. It is different from systemic HRT such as patches, tablets, sprays or gels, which are used for symptoms such as hot flushes and night sweats.

For most people using local vaginal oestrogen, progesterone is not usually needed for endometrial protection.

When should you seek medical advice?

You should seek medical advice if:

• You have recurrent UTIs
• Symptoms keep returning after treatment
• You have blood in your urine
• You have fever, chills, back pain or flank pain
• You are pregnant
• You have pelvic pain
• You have unexplained vaginal bleeding
• You have bleeding after menopause
• You have a personal history of breast cancer
• You are unsure whether symptoms are UTI, thrush, BV or vaginal dryness
• Postmenopausal bleeding should always be checked.

Pharmulous advice

Vaginal dryness and recurrent urinary symptoms are common, but they should not be ignored.

If you are experiencing dryness, soreness, painful sex or repeated UTI symptoms, a clinical review can help identify whether vaginal oestrogen, non-hormonal moisturisers, UTI treatment or further GP assessment is most appropriate.

At Pharmulous, our clinicians review your symptoms and medical history to help ensure treatment is safe, suitable and appropriate for you. Where appropriate, treatments such as Estriol 0.1% cream, Estriol 0.01% cream, Vagifem® vaginal tablets and Lenzetto spray may be recommended following a clinical assessment.

Research and clinical references

• NHS: Menopause and perimenopause symptoms
• NHS: Urinary tract infections
• NICE menopause guideline NG23
• NICE recurrent UTI guideline NG112
• NCBI StatPearls: Atrophic Vaginitis
• NCBI StatPearls: Recurrent Urinary Tract Infections