05/27/2015 12:31 pm ET Updated May 27, 2016

UTIs and Menopause

Eric Audras via Getty Images

Are you feeling overwhelmed trying to make sense of what's happening to your body during the change? Are you noticing really annoying symptoms like vaginal dryness, painful sex or vaginal infections? So many women experience these symptoms as a result in part from lower estrogen levels. What you may not realize is that you may also be at increased risk for urinary tract infections or UTIs during the change. Here's why.

The tissues of the reproductive tract and urinary tract are very sensitive to estrogen. As women transition from their reproductive years into, through and beyond menopause, estrogen levels get lower and the tissues respond. During the reproductive years, the end of the urethra, the tiny tube that carries urine out of the bladder, typically ends flush with the tissues of the upper vagina. As estrogen levels lower, the tissues of the upper vagina pull back from the tip of the urethra, exposing the tip to more bacteria and potential infection.

Estrogen also has other effects on the urinary tract. It encourages the bladder to produce natural antimicrobial substances and also helps the bladder cells to thicken in number and move closer together to keep out bacteria -- like a first defense against infection. So when estrogen levels fall, it is not surprises that UTIs rise.

So what can you do if you are getting UTI's as part of The Change?

For some women, doctors recommend staying on chronic low-dose antibiotics such as nitrofurantoin. Because so many antibiotics are leading to resistance, this is becoming less popular.

Cranberry extract (not drink but the concentrates of the berry) is another approach. It works by making the urine more acidic, which may lower the risk of UTIs. For some it is helpful but the study results are mixed. It can't hurt but may not keep UTIs away.

Probiotics are another alternative. Studies show that taking oral lactobacillus twice daily can be helpful, but not as effective as antibiotics. You can take them by mouth and the higher the concentration of lactobacillus, the more effective. Compare labels for the one with the most "good" bacteria in them. The good news; they don't cause bacterial resistance.

Let's go back to the beginning of our discussion, where I talked about UTIs and low estrogen levels. I think one of the most effective ways to prevent recurring UTIs is low dose estrogen - if your doctor feels it is safe for you and it is something you are comfortable taking. All you need is local estrogen and that can be in the form of a tablet, cream or vaginal ring. Local estrogen mostly stays in the vaginal area, but some forms do get into the blood stream so discuss this with your doctor. One Dutch study compared one year of either local estrogen or chronic antibiotics in 252 women. The women initially had an average of seven UTIs per year. Local estrogen and continuous antibiotics both reduced the number of infections by roughly half. The local estrogen can also help vaginal dryness, painful sex and prevent antibiotic resistance. It's my first line choice in preventing UTIs in menopause.

To discover more Changes During the Change, download my Free EBook: Changes During the Change: What to Expect and What to Do About It. My latest book, The Estrogen Window, is due out from Rodale in April 2016.