Why Do Older Women Get UTIs? A Naturopath’s Guide to Prevention

Around half to two thirds of women will experience a urinary tract infection at some point in their lives, and the risk rises with age. Many women first notice recurrent bladder infections during perimenopause, when changing hormones alter the tissues and microbiome that normally protect the urinary tract. If you are frustrated by repeat infections, understanding what changes with menopause is the first step to prevention.

Hormonal shifts are the main reason UTIs increase in this stage. Falling and fluctuating estrogen levels thin the vaginal and urethral lining, reduce protective secretions, and make it easier for bacteria to colonise. These changes remove a natural barrier that once helped keep bladder infections at bay.

In my naturopathic practice I’ve seen clients reduce UTI recurrence dramatically by addressing those hormonal and mucosal changes alongside simple lifestyle strategies. For many women a combination of hydration, microbiome support, and targeted herbs and supplements, can cut recurrence and restore confidence.
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This article explains the hormone–bladder connection, and provides practical natural and integrative steps you can take to lower your UTI risk.

The hormone–bladder connection

How estrogen supports urinary health

Estrogen helps keep the vaginal and urethral tissues thick, elastic and well lubricated. It supports the growth of protective Lactobacillus bacteria and the production of antimicrobial substances in the mucosa. Together, these factors reduce bacterial adherence and lower the chance of bladder colonisation.

What happens when estrogen drops

When estrogen declines in perimenopause, tissues become thinner and drier, protective mucus decreases, and Lactobacillus levels fall. A higher vaginal pH and reduced mucosal immunity make it easier for common bladder bacteria, such as E. coli, to take hold.

Other factors that raise UTI risk in perimenopause

●   Vaginal microbiome shifts:  Loss of Lactobacillus dominance lets opportunistic bacteria increase.
●   Immune ageing:  Natural changes in immune responsiveness can make infections more likely and symptoms less predictable.
● Pelvic floor and bladder emptying:  Weaker pelvic muscles and incomplete bladder emptying create a reservoir where bacteria can multiply.
​●   Sexual activity and products:  Intercourse, spermicides, and some lubricants can disturb flora and raise short-term risk.
●   Lifestyle triggers:  Low fluid intake, excess caffeine, high sugar intake, and poor hygiene habits all contribute.

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Recognising UTIs in perimenopause

Typical symptoms

Burning on urination, urinary urgency and frequency, cloudy or strong-smelling urine, pelvic discomfort, and sometimes blood in the urine.

​When symptoms overlap with genitourinary syndrome of menopause

Vaginal dryness and irritation can mimic UTI symptoms, burning, urgency and frequency, without a bacterial infection. This is why testing is important before assuming every flare is a UTI.

When to seek medical care

Contact your GP promptly if you have fever, chills, side or back pain, vomiting, blood in urine, severe worsening symptoms, or recurrent infections (two or more in six months, or three or more in a year). Repeat symptoms should trigger a proper evaluation to rule out anatomical, functional or other causes.

Natural and integrative ways to support bladder health

Hydration and bladder-friendly choices

Aim to spread fluids throughout the day. Adequate water intake helps flush bacteria before they can adhere. Reduce bladder irritants such as high caffeine, alcohol and highly acidic or sugary drinks.

Drink regularly throughout the day to keep the bladder flushed and less hospitable to bacteria

Support the vaginal microbiome with probiotics

Lactobacillus-focused probiotics, taken orally or deployed locally, can help restore a protective vaginal environment. Discuss strain and formulation with a Naturopath for best results.

Cranberry extract and D-mannose — prevention tools

Cranberry contains compounds that can reduce bacterial adhesion to bladder cells; high-quality standardised extracts are generally used for prevention. D-mannose, a simple sugar, can block E. coli from sticking and is used by many women to reduce recurrence. Evidence varies but both are low risk for most people and can be considered as part of a prevention plan.

Cranberry and D-mannose may help prevent recurrent UTIs by stopping bacteria from sticking to the bladder wall

Herbal and practitioner-strength options

Traditional urinary herbs such as uva ursi, buchu and cornsilk have been used to support bladder health. Herbs should be chosen and dosed by a qualified practitioner, especially where prolonged use or interactions are possible.

Herbal urinary support can help, but only when provided in high-quality, practitioner-guided formulations

blog: Natural Remedies for uti

Collagen, magnesium and systemic support

Collagen peptides, magnesium and omega-3s are supportive for tissue repair, muscle relaxation and lowering systemic inflammation, factors that indirectly help the urinary tract and pelvic floor.

Pelvic floor health and bladder emptying

Pelvic floor physiotherapy and exercises improve bladder emptying and reduce residual urine. Better emptying lowers bacterial growth risk and supports continence.  Everyday habits that make a difference
●   Urinate after sex and avoid holding urine for long periods.
●   Wipe front to back and choose breathable underwear.
●   Avoid harsh soaps, douches and strong fragranced products.
●   Keep blood sugar stable and manage constipation which can affect bladder emptying.

Medical and clinical options to consider

Local vaginal estrogen

If UTI's continue to be a problem, topical low-dose vaginal estrogen restores tissue integrity, reduces dryness, and encourages Lactobacillus recolonisation.  Making it an effective option to prevent recurrent UTIs related to hormonal loss. Discuss safety and suitability with your GP.

Integrative assessment

If UTIs recur, an integrative approach looking at hormones, microbiome, pelvic mechanics, and lifestyle usually yields the best long-term results.

Conclusion: Natural remedies as an effective alternative

UTIs become more common as estrogen falls during perimenopause, but they are not an unavoidable part of ageing. A broad, evidence-informed approach that supports the vaginal microbiome, strengthens pelvic floor and bladder function, and uses targeted natural options can dramatically reduce recurrence for many women.

Natural measures such as improved hydration, Lactobacillus probiotics, cranberry extract or D-mannose, pelvic floor therapy, and practitioner-guided herbal and supplement support are practical, low-risk strategies to try before, or alongside, medical treatments. For women with recurrent infections, topical vaginal estrogen is an effective option that repairs mucosal defenses.
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A qualified naturopath can help you design a personalised plan and guide you to high-quality natural supplements. When combined with simple lifestyle strategies, this approach offers the best support for preventing UTIs and staying well through perimenopause and beyond.

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Key takeaways
●   Perimenopause increases UTI risk because falling estrogen thins the urinary and vaginal lining.
●   Hydration, probiotics, herbal medicine, pelvic floor care and avoiding irritants are first-line natural prevention steps.
●   Local vaginal estrogen is an effective medical options for recurrent, hormone-related UTIs.
●   See a clinician if you have fever, back pain, blood in urine, or repeated infections.

​Vanessa Winter
​Naturopath & Medical Herbalist
BHSc (Deans Award for Academic Excellence), BED, Adv.Dip.Nat., Adv.Dip.Herb.Med., NMHNZ
​Registered with Naturopaths and Medical Herbalists of NZ (NMHNZ)

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