bladder infections (utis) in women after menopause infectifections in elderly women.pdf · •...
TRANSCRIPT
a program of Morningside Ministries
Bladder Infections (UTIs) in Women after Menopause Christopher W. Graham, MD Urology San Antonio
The Problem
• Onset: About 5 years after menopause or stopping estrogens • UTI’s occur more frequently. • UTI’s more common after sex
The Cause
• Estrogens support vaginal health • Help good bacteria (lactobacillus) grow in the vagina, • Stops intestinal bacterial growth in the vagina
• With menopause, vagina suffers • Intestinal bacteria replace lactobacillus • These bacteria more easily enter the bladder
The Solution
• Symptomatic infections should be treated • Occasional infections can be treated when they occur • Frequent infections should be treated with prevention
Asymptomatic Bacteriuria
• Bacteriuria without symptoms should not be treated
• Fictitious bacteriuria common with contamination in vagina
• Constitutional symptoms may be the only symptoms of a UTI
Restoring Vaginal Health • Cleaner is not better. Vaginal washes, douches, and soap vaginally kill lactobacillus. • Probiotics to restore lactobacillus growth vaginally
• Oral probiotics show marginal benefit • Vaginal probiotics have limited data
• Vaginal suppositories • Finger application of powder from probiotic capsule
• Vaginal moisturizers • Reduce discomfort of vaginal atophy • May not have a benefit for reducing infections.
Vaginal Estrogens: Benefits
• Estrogens help the good lactobacillus grow normally • Estrogens improve vaginal function, including sexual function
Vaginal Estrogens: Risks
• Estrogens absorbed vaginally, but often lower blood levels than with systemic estrogens. • Estrogen +/- progesterone risks
• Breast cancer • Uterine cancer • DVT and other cardiovascular risks