This morning I took a phone call from Claire*, a 70 year old woman who was struggling with recurring, confirmed bladder infections. Diagnosed with IC two decades ago, her infections began only recently and occurred about every 4 to 6 weeks. After several rounds of antibiotic treatment, she was very frustrated. “Why were they happening? Does this happen to other IC patients?” she asked. My answer is “Yes, for a small population of patients, recurring UTI’s do occur. One common risk factor is menopause.”  

When a woman enters peri-menopause and menopause, her body produces lower levels of estrogen. Estrogen is essential to skin health and the production of mucus on our vulva, in the vagina, urethra, bladder and mouth. In the bladder, for example, that thick layer of mucus helps repel toxins and bacteria from reaching the more fragile cells beneath. With aging, the protective layer thins and makes the bladder far more vulnerable to infection. Claire, at the age of 70, produces very little estrogen and her doctors had already told her that her skin was very thin. They had even provided an estrogen cream for her to use but she said “I never use it. I never thought it was important.” 

In a lecture I attended years ago at the American Urology Association Annual Meeting, Dr. Anthony Schaeffer explained that when studying post menopausal women with recurring UTI, bacteria are usually first found in the vagina a day or two before it reaches the bladder. This left researchers to ask “why has the vagina become a safe haven for bacteria?” This, too, he blamed on estrogen atrophy.  In addition to an antibiotic, he explained that these women are usually prescribed an estrogen cream to help restore the skin and mucus.

Estrogen atrophy doesn’t just occur in the “mature” woman. It can also happen to patients struggling with hormonal balance, patients taking Lupron to reduce endometriosis and/or those who have had hysterectomy. And, it is inevitable. After menopause, skin thinning becomes far more noticeable. Menopausal women often report burning and itching in the vulva and vagina. Even the skin around the rectum can become more sensitive.

The good news about Claire is that her doctors had already given her the most important tool to restore her skin health, an estrogen cream but there were a few other things that I suggested as well:

  1. Use A Peri-Wash Bottle – After every visit to the restroom, use a peri-wash bottle to rinse any bacteria from your skin then pat dry with toilet tissue.
  2. Water Intake – Drink 6 to 8 glasses of water a day to help flush bad bacteria from the urinary tract.
  3. Very Private Body Wash – Some women have reported that Very Private Body Wash helpful in reducing bacteria on the skin.
  4. Probiotics – Take probiotics to help restore beneficial bacteria in the gut. These then help to control pathogenic bacteria.
  5. Try D-mannose – A simple sugar not used by the human body, D-Mannose is immediately excreted via our urine where it can help repel some E. coli infections. Researchers in England compared the effectiveness of D-Mannose with Microbid in the prevention of recurring UTI in 308 women. The results found that D-Mannose performed as well as Microbid but with significantly fewer side effects.(1)
  6. No Cranberry Products – Despite the hype, the strong acids of the cranberry are just far too irritating for patients also struggling with interstitial cystitis.

Of course, once infection is present, a physician will generally use the results of an antibiotic sensitivity test to determine the correct antibiotic to use. While you might be tempted to just take some left over medication from a previous infection, it’s very important that you have the proper testing done with your current infection. Left untreated, bladder infections can move into the kidneys where they could become life threatening.

Claire, like so many of us, experienced side effects and bladder burning from one of the antibiotics she was given. If one antibiotic causes more bladder irritation, call your physician and ask if another could be tried. Step up and do your research about that antibiotic too. Read the insert that comes with the bottle. Familiarize yourself with potential side effects. Some antibiotics, such as Cipro, are no longer suggested for simple UTI treatment because of their risk of severe, life threatening side effects.

Last but certainly not least, remember that antibiotic treatment destroys both good and bad bacteria which then creates a foundation for candida overgrowth or C/ Diff infections. Don’t forget to take probiotics (i.e. acidiphilous products, Culturelle, yogurt with live cultures, etc.) to quickly restore the beneficial bacteria in your body.



1. Altarac S, Papes D. Use of D-Mannose in prophylaxis of recurrent UTI. BJU Int. 2014 Kam;113(1):9-10

*Name Changed For Privacy

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