Yikes and - more importantly - OUCH!

We have some great blogs on ways to keep the vagina, bladder and entire genitourinary complex UTI free (Hello, D-Mannose…), but something that is equally important is understanding a few key things:

1. Why do UTI’s often become more frequent as we age?

2. Why aren’t antibiotics working, or, why do they work only for a UTI to return a week later?!

3. How does UTI presentation change with age (yes, sometimes we don’t FEEL a UTI!)

4. What are the dangers of repeat (or untreated) UTI’s?

So, let’s take a look…

Why Do I Get More UTI’s Than Ever Before?

There are some basics to UTI hygiene that many women already know - things like avoiding soap in the urethra, avoiding using pads that can transfer bacteria, peeing after sex, and changing out of sweaty lycra. Plus, there are the well known lifestyle factors - things like drinking enough water and avoiding sugar, that can play a role in UTI frequency and severity.

But let’s face it, getting a UTI once a month isn’t adding up even if you did hang out in sweaty lycra and skip water at lunch.

There is a strong link between estrogen levels and UTI frequency, especially as women go through menopause and beyond. Estrogen is critical for urethral, vulva, and vaginal health and the drop in estrogen after menopause often means an increase in UTI’s. Estrogen - and in particular estriol - the gentlest form of estrogen can really help.

How? Well, let’s take a look at some of the key ways:

Skin cell health: The decline in estrogen means it is important for keeping the outer layer of cells healthy and - perhaps most importantly - encouraging healthy cell turnover.

Collagen reserves: collagen (as we may all know from constant advertising bombardment…) keeps wrinkles at bay - but it also helps repair tissue damage. As we age, the skin of the urinary tract (and vulva and vagina) loses collagen and starts to thin. Thinning skin can result in small micro tears. Collagen helps with repair and wrinkle fighting - something that is needed to prevent bacteria transfer. And, estrogen is important for collagen formation.

pH Balance: the Vaginal Microbiome is acidic, which helps kill off bacteria that should not be there - but without estrogen, the pH can rise, creating an environment where bacteria can flourish. More vaginal bacteria can increase the chance of spreading to the urethra.

Mucous membranes: One of estrogen’s super important functions is mucous membrane health. When mucous membranes ‘get thinner’ we feel this as a drying of the tissue. This has a big ripple effect - we itch more (and/or apply things to mitigate itch), leading to weaker skin, more damage, and more ways for bacteria to thrive - and move around - and potentially enter the urethra!

So, it’s not one simple problem, but more the overall decline in estrogen that creates an environment where bacteria can get a stronger foothold and have an easier time spreading from anus, perineum, and vagina, into the urethra.

The Antibiotic Dilemma

But, if a UTI is just bacteria, why doesn’t a good strong dose of antibiotics do the job?

Well, there are a few reasons for this one too…

• Not all UTI’s are equal; by that we mean, they don’t all respond to the same antibiotics.
• Antibiotic resistance is on the rise - especially if not taken properly.
• Antibiotics kill good and bad bacteria in equal measure - and our vagina thrives on the health of its microbiome.
• Antibiotics don’t fix the underlying issue of why UTI’s are happening - they only treat the symptom.

So, Why Don’t All UTIs Respond to the Same Treatment?

What Else?

Repeated courses of antibiotics can disrupt the vaginal and gut microbiomes, eliminating not only harmful bacteria but also the good bacteria that help maintain pH, immune function, and tissue integrity.

This disruption makes women more prone to yeast infections, digestive problems, and (ironically) future UTIs. Heavy antibiotic exposure also increases the chance of antibiotic resistance, meaning the usual medications may stop working as well. This doesn’t mean antibiotics should be avoided when they’re needed; it simply means that prevention, tissue support (like estriol for mucosal health), and targeted treatment strategies matter!

UTI Impact - From Discomfort to Death

No really.

As many of us become caregivers to elderly parents (or already are), it is important to understand the seriousness of UTI’s; what can be a nuisance in our younger years can be much more dangerous to older women - and so UTI’s often get missed.

In fact, studies have shown that not only are UTI’s one of the most frequently diagnosed infections in older adults (between 15-30%), around 6.25% of infection-related deaths in elderly patients are attributed to UTI’s.

Let’s compare:

Younger Women (‘Typical’ Presentation)

🔥 Burning with urination (dysuria)
🚽 Urgency and frequency
🌫️ Cloudy or strong-smelling urine
⚡ Lower abdominal or pelvic pain
🩸 Occasionally blood in urine
❗Symptoms appear quickly and are easy to identify
🧠 Mental status stays normal
🦠 Usually localized infection without systemic symptoms

Older Women (Atypical or ‘Silent’ Presentation)

🧩 Fewer urinary symptoms - often no burning
💤 Generalized fatigue or “feeling off”
🤒 Low-grade fever or no fever at all
🧠 Confusion, delirium, agitation, or sudden behavioral change
🥴 Dizziness, falls, or unsteadiness
🍽️ Loss of appetite
⚕️ Worsening of existing conditions (incontinence, dementia, frailty)
🩺 Symptoms may be vague, slow to appear, or misattributed to “age”
🚑 Higher risk of rapid progression to serious infection (e.g., kidney infection or sepsis)

As you can see - for younger women, or UTI’s with more common symptoms stay localized to the vaginal-urethral complex, with some women complaining of pelvic or abdominal pain. In comparison, for older women , there are often more cognitive issues that caregivers may not associate with UTI’s.

The Dangers of Untreated UTI’s

An untreated UTI doesn’t always stay “just a bladder infection.” In many women (especially in midlife and beyond) the bacteria can travel upward from the bladder into the kidneys. Kidney infections (pyelonephritis) can lead to high fever, lower back pain, and sometimes hospitalization. If the infection continues to spread, it can enter the bloodstream, causing urosepsis, which is serious but preventable with timely treatment.

Even when complications don’t escalate that far, untreated infections can still cause ongoing inflammation, bladder irritation, and worsening urgency or frequency that disrupt daily life. While not everyone will be affected this way, it’s vital to solve a UTI to reduce the risk of it getting complicated.

Someone with repeat UTI’s does need to have a longer conversation with their doctor about what are the options for a lasting solution. There is however, some cool science about estrogen that is worth knowing.

Silky Peach Cream - Estriol For Longer Term Relief

From the 50 year old with recurrent UTI’s to the 80 year old - estriol offers the ability to replenish estriol and supply the tissues with the necessary building blocks to manage long-term UTI prevention.

Silky Peach cream offers topical estriol that can be applied directly to the skin of the vulva, helping replenish estriol and rejuvenate the tender tissues and maintain the overall health and integrity of the entire genitourinary complex!

Watch more here: