Hormone replacement therapy, shortened to HRT, is a form of therapy that menopausal women take to artificially get female hormones – Estrogen and progesterone which are usually in continuous decline during menopause onset as during menopause, the body finds it difficult to produce these hormones anymore through the natural biological pathways.

Hormone replacement therapy is commonly used to ease conventional menopausal symptoms like hot flashes, night sweats, and vaginal discomfort; testimonials from menopausal women also prove that HRT is effective in managing bone density loss and fractures.

Other menopausal that it can hormone replacement therapy can help ease include:

• Cold flashes

• Low Sex drive (low libido).

• Urinary urgency due to dysfunction of the bladder muscles.

• Sleeplessness (insomnia).

• Brain fog, irritability, anxiety and mood swings, and mild depression.

• Scaly and dry skin, eyes and mouth, etc.

• Tooth loss.

• Reduced risk of colon cancer.

• Reduced risk of diabetes.

• Improvement in joint pains.

• A general decrease in the death rate of women undergoing the menopausal transition

In Hormone replacement therapy (HRT), factors like age, personal medical history, family medical history, the severity of menopausal symptoms, etc., are considered before the type (choice) and dosage of these hormonal medications are administered; and it is advised that the risks and benefits of the available hormonal therapy be discussed with the healthcare personnel(s) before going for any type and dosage.

As earlier stated, hormone replacement therapy (HRT) focuses on augmenting or replacing the levels of estrogen (mostly) and progesterone that the body can no longer produce during pre-menopause or after menopause.

What is Estrogen?

Estrogens are groups of hormones that play vital roles in developing secondary sexual characteristics concerning reproductive development in women; they are otherwise called sex hormones. The ovaries of females of reproductive age make most estrogen hormones, although the adrenal glands of the kidneys’ adrenal cortex and fat cells of adipose tissues also make manageable amounts of the hormones.

What role does estrogen play?

Estrogen plays a major role in many biological processes, especially in reproductive development in females of reproductive age (women); these roles include:

• Thickening of the uterine lining (wall) in readiness for the possible implantation of a fertilized egg during ovulation.

• Influencing the body’s uptake and use of calcium – an essential mineral in bone-building and functions.

• Maintaining healthy levels of blood cholesterol.

• Maintaining the vagina’s health.

• Preventing loss of bone mass (osteoporosis) by making calcium available for uptake.

What is Progesterone?

Progesterone is one of the main pro-gestational steroid hormones secreted by the female reproductive system, particularly the corpus luteum of the ovaries, and is usually linked to menstruation, pregnancy, and fetal development. It is synthetically available as progestin and useful in many medical diagnoses and treatments, like menopause-related Hormone replacement therapy.

What peculiar role does progesterone play?

Progesterone plays vital roles in many body biological processes, which include:

• Preparing the uterus (womb) to implant a fertilized egg(s).

• Maintaining pregnancy and fetal development.

• Regulating the blood pressure.

• Improving and managing mood and sleep.

Why Menopausal women take Hormone Replacement Therapy

Menopausal symptoms can present women going through a menopausal transition with great discomfort and restlessness, and the psychological impact of always feeling sickly and not being able to explain their body system anymore is always the propelling force why they seek refuge in taking hormone replacement therapy as a remedy to get at least some easing for the menopausal symptoms.

And thus, benefits derived from hormone therapy are always the push for menopausal women against the slight risk accompanying different types of HRT.

Below are some of the reasons (benefits) why women take hormone replacement therapy: –

• Managing and easing mild and intense hot flashes:- according to reports, systemic estrogen therapy effectively manages problematic menopausal symptoms like night sweats and hot flashes.

• Easing and management of other menopausal symptoms: – Estrogen can also ease other menopausal symptoms like vaginal dryness, vaginal itching, burning sensation, and low sex derived from discomfort in the vagina due to dryness.

• Prevention of bone density loss and breakage: – Estrogen therapy taken directly into the bloodstream also protects the bone mass of menopausal women against bone-thinning and loss of mass – a disease known as osteoporosis.

• Managing premature menopause and having estrogen deficiency:- hormone replacement therapy, especially estrogen, always serve as a relief for women who are experiencing earlier menopause, probably due to the surgical removal of ovaries due to one condition or the other before the age of 40, and invariably stopped menstruating before 40 years (premature menopause) or when the ovaries become dysfunctional and have lost normal functions by late 30s (usually referred to as primary ovarian insufficiency), during which the body has been exposed to too little estrogen level as even sometimes far less than the levels produced by bodies of menopausal women.

Types of hormone replacement therapy (HRT)

There are three (3) main types of hormone therapy (HT) available for menopausal women; they include:-

• Estrogen Therapy: – Estrogen can be taken alone or combined. Healthcare practitioners often prescribe a low dose of estrogen as pills or patches daily, such as a tropical cream, vaginal ring, vaginal gel, or vaginal spray. Menopausal women are advised always go for the lowest dose of estrogen to relieve menopause symptoms. Estrogen therapy is also a good relief for women experiencing early menopause after surgical removal of the womb (hysterectomy) and bilateral saphingoophorectomy alongside hysterectomy (surgical removal of the ovaries, fallopian tubes, and the uterus) such that the ovaries are no longer there or now dysfunctional in producing the natural estrogen.

As stated earlier, estrogen hormone therapy comes in different forms: pills, patches, vaginal rings, vaginal creams, and topical gels.

• Estrogen pill:- Pills are the most commonly used estrogen hormone therapy for menopause and related symptoms. There are two main forms of this estrogen pill available: conjugated estrogens orals like Estratab, Cenestin, Premarin, Estrace, Ogen, Femtrace, etc., and estrogens-bazedoxifene orals like Duavee, etc.

Menopausal women taking estrogen pills options are advised to adhere to the doctors’ instructions on dosing as most estrogen pills are to be taken daily without food, while other forms have more complicated dosing schedules.

• Estrogen patch:- The estrogen patches are usually worn on the skin of the abdomen. Depending on the prescribed dosage, some patches are replaced every 2- 3 days, while others can be worn longer, up to a week. Estraderm, Climara, Viville-dot, menostar, and Alora are examples of these estrogen patches. Other estrogen patches are in combination form – Estrogen and progestin patches, e.g., Combipatch and Climara Pro.

Menostar has a normal estrogen patch with a lower, if not the lowest, dose of estrogen than other patches, and it’s only effective in reducing the risk of osteoporosis (loss of bone mass and fracture) and does not ease or manage other menopausal symptoms.

• Topical estrogen:- Synthetic estrogens in creams, gels, and sprays form and offer another route of obtaining estrogen into the systems of menopausal women. Topical estrogen includes gels – Divigel and EstroGel; sprays –  Evamist and Evamistcreams, e.g., Estrasorb.

Just like patches, this type of estrogen hormone treatment is also absorbed through the skin route directly into the bloodstream, and the directives on how to apply these creams vary depending on the concentration of the active ingredient and manufacturers’ information, although most topical estrogen is usually used once a daily. Topical EstroGel is usually applied on one arm, from the wrist to the shoulder, topical Estrasorb is applied to the legs, and topical Evamist is applied to the arm.

• Vaginal estrogen: – Topical Vaginal estrogens are available in cream forms and vaginal rings, and then vaginal estrogen tablets. Generally, these estrogen treatments are for women going through menopause transition who are troubled specifically by vaginal itchiness, burning sensation, and dryness pain during intercourse. These vaginal estrogen therapies include tablets like Vagifem, creams, e.g., Premarin or Estrace, insert- able rings like Femring or Estring.

Just like other estrogen therapy forms, vaginal estrogens also follow dosing schedules, which may vary based on the doctors’ prescription and manufacturers’ information on the product (s). Most vaginal rings are to be replaced every three months for safety reasons; the vaginal estro-tablets are used daily for only a couple of weeks, after which the dosing becomes just twice a week, while the vaginal topical creams may be used daily; many times a week, or according to a different schedule.

Pros of Estrogen Therapy

Estrogen is known mostly for its vital role in the reproductive system. According to research, it is also very helpful research now shows that estrogen helps almost every organ system of the body, especially in a woman. Below are a few of the core roles of biological estrogen and the same role estrogen therapy tends to mimic.

• Protection of the heart and improving the heart functions

Estrogen is great for the heart by keeping the heart tissue healthy and also helps with keeping the blood pressure stable.

Therefore, when the estrogen levels are high, it helps manage and keep blood triglycerides low, increases high-density lipoproteins (HDL) cholesterol, and keeps low-density lipoprotein (LDL).

Although the link between estrogen and the heart is still under serious research, for instance, recent studies have it that the risk of developing cardiovascular disease is high for individuals who had undergone bilateral oophorectomy (the surgical removal of both ovaries and fallopian tubes) before menopause.

• Brain Protection

Both the natural and artificial estrogen (estrogen therapy) roles are well associated with the brain as it protects the brain by ensuring and maintaining proper blood flow through to the brain.

Estrogen also protects against inflammation of the brain cells due to oxidative stress and disease, assisting greatly with memory and fine motor skills improvement, especially in stroke management.

Estrogen’s role, as mentioned earlier, in brain protection explains why estrogen is very effective in managing brain fog as one of the symptoms of menopause.

A study shows that the more an individual has been exposed to estrogen, whether natural or artificial, the healthier and better their brain health is as they age.

• Improving muscle mass and bone density

The estrogen hormone plays vital roles in the growth of bone cells and improving muscle mass, explaining its effectiveness in managing osteoporosis – a health condition in which bones become weak and brittle due to loss of cells and loss of bone mass, predisposing the bone to fracture any slightest accident.

During the menopausal transition, bone mass readily decreases with the decrease in estrogen level, further confirming estrogen’s vital role in bone and muscle maintenance and why estrogen therapy is generally embraced by menopausal women in managing osteoporosis – one of the troublous symptoms of menopause.

• Managing Anxiety and Boosting the mood 

Mood swings during menstruation and the notable anxiety and depression occurring during menopause are said to be due to the fluctuating and decreasing levels of estrogen, respectively; as the hormone – Estrogen is known as a trigger for the secretion of serotonin (the feel-good hormone) and the sister endorphins that together help in nerve functions and growth; and muscle relaxation.

• Improving sex drive

Estrogen is very important when improving and maintaining healthy sex life, especially in women, by keeping the vagina lubricated; as estrogen level has a very close link with vagina lubrication because studies have confirmed that when estrogen levels become too low; the vaginal walls become thinned and produces less lubrication and vise versa.

The above reason explains the loss of elasticity of the vaginal walls and the subsequent drop in sex drive in women going through the menopausal transition and the reports of painful sex, and thus, the relief that topical vaginal cream estrogen therapy and the likes give to menopausal women.

Cons of Estrogen Therapy

Estrogen hormone therapy has some side effects; although not to be compared to its benefits, it is also good to know the counter effects before going for estrogen hormone therapy. These side effects include:

• vaginal bleeding

• Swelling in other body parts (Face, legs, etc.)

• Swelling and tenderness of the breast

• indigestion

• Headaches (Slight and sometimes serious)

• a feeling of being unwell

• Cramps in leg

• Bloating (gas in the stomach)

• Estrogen Progesterone Hormone Therapy (EPT):- a hormone replacement combination therapy that is a combined dosage form of estrogen and progestin (synthesized progesterone); the reason is also referred to as estrogen-progestin therapy.

EPT is usually best recommended for women undergoing menopausal transition whose uterus is still intact, as this combination therapy reduces the risks of endometrial and uterine cancers compared to only estrogen therapy.

Although progesterone is generally used for birth control, it is effective in easing and managing menopausal symptoms like hot flashes and night sweats.

Estrogen-progesterone/Progestin Therapy can be administered in two forms:

• Oral progestins, and

• Intrauterine Progestins

• Progestin Patches

• Oral progestins:- these forms of EPT are taken orally as medications and pills. The oral EPT includes progestin medications like Provera (medroxyprogesterone acetate) and the progestin pills like norethindrone, norgestrel, Bijuva, Angeli, Prempro, etc.

Many healthcare experts now manage most menopausal symptoms with organic progesterone rather than synthesized progestins. According to research, organic progesterone is indirectly associated with lipids and thus helps to manage high cholesterol levels in menopausal women compared to its synthetic form – progestin.

• Intrauterine progestin:- This form of EPT comes as a Low-dose intrauterine device (IUD) and, as the name implies, is administered to the walls of the uterus. IUDs are available as levonorgestrel, a trademarked name, and sold under the following brand names – Skyla, Liletta, Mirena, and Kyleena.

Intrauterine devices are approved for family planning and bleeding control in the USA and are sometimes administered “off-label” with estrogen. Women with IUD implants are advised not to remove them even during menopause transition until after the transition has been completed. It helps curb irregular menstrual cycles in the premenopausal stage and ease menopausal symptoms when menopause has fully set in.

Progestin Patches include:- Combipatch, Climara-pro, etc.

Benefits of EPT

The EP hormone combination therapy serves a dual benefit as it combines the benefit of estrogen, as already discussed above, and that of progesterone which involves blood pressure regulation and mood improvement, among many others already discussed earlier.

Disadvantages or side effects of Estrogen-progesterone (progestogen) hormone therapy

Below are some side effects of using the EP combination therapy; although these side effects cannot be equated to the great benefits reported by menopausal women on the use of this remedy; and as well differs for each person depending on the individual body’s reactions and acceptance of the therapy:

• Abdominal upset
• acne
• breast tenderness
• depression
• Migraines
• mood swings
• pain in the lower back
• swelling in other parts of the body
• vaginal bleeding

3. Vaginal dehydroepiandrosterone (DHEA) Hormone Therapy:- also known as prasterone vaginal therapy. Prasterone is the synthetic form of a hormone known as dehydroepiandrosterone (DHEA) which is normally secreted by the adrenal gland of the kidneys and on its own inactive until it is converted to estrogen and androgen, which are active sex hormones.

Vaginal dehydroepiandrosterone HT is usually in the form of vaginal inserts; a commonly known brand is Intrarosa.

Is menopausal Hormone Replacement Therapy expensive?

One of the top questions most menopausal women seeking hormone replacement therapy ask first is what the overall cost of hormone therapy treatment, as much as this is an honest inquiry from a place of sincere concern as most insurance plans do not cover the cost of such treatment, it is still a factual matter that HRT is one of the most affordable treatments for menopausal symptoms.

According to research, the average cost of hormone replacement therapy is 30 – 90 USD per month. And thus, the cost of individual treatment within this new range will depend on other factors like dosage, treatment type, and choice; and if there is any other underlying health condition to be treated alongside.

Another reason for Hormone Replacement Therapy to save on cost;

As already stated about the significantly lowered cost of this treatment as against other treatment methods like surgeries and other medications; there are many other ways this treatment helps in saving cost, and they are:

1. Curtailing and curbing Spending on Other Medications

Going for hormone replacement therapy helps curb the use of other medications in managing menopausal symptoms, like buying sex enhancement medications when trying to manage a low sex drive.

2. Drastic reduction in the Cost of Other Therapies

Using almost the same cost budget to get hormone therapy will help address all the symptoms that other therapies like bone surgeries and the like would have cost, and invariably lowering cost or co-pay is required for these other therapies.

3. Spend Less on Lifestyle Costs

Financing a lifestyle and using dieting to remedy menopausal symptoms is not always a walk-in-the-park cost-wise, so hormone replacement therapy is always handy and is typically powerful enough to reduce or not eradicate the need for other non-medical treatments.

Is Menopausal Hormone Replacement Therapy safe?

Yes, to an extent, as it presents the body with a lot of benefits when compared with associated risks; which is almost inevitable for most medications, but to be able to measure the level of safety associated with hormone therapy as most of the benefits have been earlier analyzed, the associated risks will have to be demystified as well and then help individuals know how safe it is relatively.

The reports of the latest largest clinical trial showed that hormone replacement therapy which consisted of the combination therapy of estrogen-progestin pill (Prempro), presents the body with an increased risk for certain serious conditions. So while HRT helps many women through the menopause transition, the therapy, like the continuous use of other medications, is not entirely risk-free. These health risks include:

An increased risk of endometrial cancer (when using estrogen therapy alone)

• High risk of blood clots and stroke.
• Increased chances of gallstone and gallbladder dysfunction.
• High risk of dementia Alzheimer’s, especially if HRT was started after age 50.
• High risk of developing breast cancer, especially with long-term use.
• Increased risk of developing cardiovascular dysfunction
• Hormone therapy and heart disease?

 

• Hormone Therapy and Heart Functions

The effect of Hormone therapy on heart functions and blood vessels has formed a lot of hypothetical questions in recent research studies; but as yet unclear as this course still is, some studies have there are negative effects of general hormone therapy in women who has it used for over 10 years – partially suggesting how long the body can and can no longer support the treatment.

The American Heart Association (AHA) also stated in line with the proposed risk of heart disease with the use of HT, saying that it is recommended to go for HRT to prevent heart diseases, especially stroke and heart attack.

• Hormone therapy and breast cancer

Taking combined therapy of systemic estrogen-progestin as results from studies has linked it closely with an increased risk of developing breast cancer. The findings from the studies show that:

Combining hormone therapy showed a rare increase in absolute risk of less than one additional case of breast cancer per 1000 person-years of use.

There was no significant reduction in breast cancer cases seen in women with had undergone hysterectomy and are on estrogen-only therapy.

Systemic hormone therapy worsens breast cancer complications; thus, chemotherapy for breast cancer cannot go together with systemic hormone therapy.

Other Factors associated with increased risks of Hormone replacement therapy

Another study also suggested that reports on these risks and their magnitudes depend on factors like age, medical history, choice, type of hormone therapy, etc.

Age:- Reports have it that women who began hormone therapy 10 years after the onset of menopause or after age 60 have greater chances of developing the risks above, and these reports suggest being started before 60 years of age or within the first few years into menopause.

Type of hormone therapy: – The level of risks associated with hormone therapy is also dependent on the type and choice of therapy – whether estrogen is given alone or in combination with progestin, and also the dosing of therapy

Health history:- family history and individual medical histories, like if there is a risk of cancer, osteoporosis, diabetes, heart disease, liver inefficiency, stroke, blood clots, etc., are important factors in determining whether or not to go for hormone therapy.

You and your doctor should consider all of these risks when deciding whether hormone therapy might be an option for you.

Can everyone go for hormone replacement therapy (HT)?

As earlier discussed, hormone therapy (HT) is not for everyone and is therefore usually not recommended for people who are:

• Have or had cancers of the breast or endometrium.
• Have vaginal bleeding.
• Have had blood clots
• Have a had of stroke or heart attack
• Suspecting to be pregnant or pregnant for sure.
• Have liver disease.

What are the General side effects of hormone therapy (HT)?

Just like other medications, hormone therapy has counter or side effects and the most common these effects reported are:

• Monthly bleeding and Irregular spotting.
• Breast tenderness.
• Mood swings.
• Other less reported side effects of hormone therapy include:
• Fluid retention.
• Headaches (including mild and migraine).
• Skin discoloration (spotting)
• Increase in breast density
• Skin irritation

How long, then, should one take menopausal hormone therapy?

Many women usually stay on hormone replacement therapy for between 2 – 5 years or longer, as the case may be, from the onset of menopause until the menopausal symptoms stop or ease drastically. It is advised that post-menopausal women use the dose-reduction withdrawal method when they are about to stop hormone therapy rather than abruptly stop.

Hormone Replacement Therapy and Urinary Tract Infection

Recent studies show a close association between hormone replacement therapy and recurring urinary tract infections, especially in menopausal women, with the use of vaginal estrogen therapy, which can benefit the beneficial fauna – lactobacillus.

The study confirmed the use of hormone therapy to lower the risk of UTIs carried out by The American Urological Association in 2019, which suggests that healthcare professionals offer vaginal estrogen therapy to menopausal women with recurring UTIs and also to women with systemic estrogen with recurring UTIs but are not at risk of increased overdosing complications as more studies are underway to determine if or not systemic estrogen therapy has effect against recurrent UTIs.

An overview of UTIs

Urinary tract infections (UTIs) are infections in any part of the urogenital system – the kidneys, bladder, vagina, ureters, and urethra.

UTIs mostly involve the lower parts of the urinary tract and most prevalent in women than men. That is due to the anatomical structure of the female urogenital system.

Urinary tract infections could be mild, serious, recurring, or complicated, especially when it involves the kidneys, and can be life-threatening.

Signs and Symptoms of UTIs

There are frequently reported signs and symptoms of urinary tract infections; they include:

• pain during urination
• feel of burning sensation when urinating
• cloudy and odorous urine
• Lower abdominal pain
• Nausea and vomiting
• Frequent urination or feeling of full bladder a few minutes after urinating, etc.

Types of UTIs

As earlier stated, infection in the urinary tract can affect any part of the urogenital system, and as such, depending on the part affected, the infection can be of the following types:

• Urethritis – this is an infection of the urethra.
• Pyelonephritis – this is a urinary tract infection that affects the kidneys.
• Cystitis – this is a urinary tract infection that affects the bladder.

Why do menopausal women have Urinary Tract Infections?

Women have a greater risk of contracting urinary tract infections compared to men due to the natural anatomy of their reproductive system – the close linking between the vagina, rectum, urethra, and bladder and the fact that there is a community of microflora in the vagina where the good, the bad and the ugly micro-organisms live and are in the continuous competition made an available point of entry of microbes into the urinary tract possible even without extra influence.

The anatomical analysis above also holds for women going through the menopausal transition, but their level of being predisposed to these microbes and subsequent urinary tract infection is almost doubled because of the influence of the continuous decrease in the level of estrogen – a hormone known for being vital in maintaining women’s reproductive health; combining the effect of hormonal change and female reproductive system anatomy as co-factors.

Again, female urethras are shorter than males,  helping these infectious microbes reach the bladder faster once there is a disruption in the equilibrium of the vaginal microbiome, especially when bad microbes are favored; this also serves to multiply the risks of menopausal, always suffering urinary tract infections.

Why do UTIs Increase Post Menopause, and what can be done about it?

The ovaries produce and supply estrogen and progesterone throughout women’s reproductive life, but during menopausal onset, these supplies begin to thin, usually resulting in a drop in sex drive and changes in the mucosal lining of the vaginal wall as well, causing harmful organisms to thrive.

The presence of lactobacillus vaginalis champions the vagina’s defense mechanism – a microbe that helps in maintaining the pH and the elasticity of the vaginal by its action on glycogen – subsequently converting it to lactic acid, hence the acid pH.

This pH trigger wades off the harmful microbes – yeast, Candida, Chlamydia, etc.- that usually compromise the vaginal anatomy and also crawl their way up to the bladder and, in extreme cases, the kidney through the ureter. These microbes can compromise the bladder functions and infect it and maybe the kidney resulting in urinary tract infections and severe conditions, kidney infections too.

Another angle of linking menopause and UTIs is from the area of the weakening of muscles – the bladder and pelvic floor muscles due to the continuous decrease of estrogen hormone levels during menopausal transition through perimenopause; causing the bladder and pelvic floor muscles to become too weak to hold urine which results in the inability to control urination.

Other factors increase the chances of Urinary Tract Infections during menopause, and they include:

• Poor Sugar uptake (diabetes)
• a history of  recurring UTIs
• sexual intercourse with an infected partner
• Douching
• Suffering urinary or stress incontinence
• Pelvic prolapse
• Irritation of the vaginal wall
• A Compromised immunity
• Compromised anatomy of the urogenital tract
• bladder dysfunction
• Possessing a non-secretor blood type antigen in the body fluids.

What can be done about ongoing UTIs?

The management and treatment of UTIs, especially for post-menopausal women, have been sole with oral antibiotics usually prescribed by doctors after a urine culture has been performed, and the infection-causing bacteria have been determined.

Doctors advise that it is important for the recommended antibiotic dosing to be strictly adhered to and the course completed even when symptoms have subsided or disappeared completely – this is to prevent the recent concerns on the increasing bacterial resistance to antibiotics.

It is important to note that a one-off treatment will not be able to prevent future occurrences, especially in post-menopausal women, as the major cause of the whole anatomical cause that finally resulted in UTIs is still there – which is the decrease in estrogen and progesterone.

Thus, to effectively manage urinary tract infection during the menopausal transition, it is best that lifestyle changes – in terms of good dieting and exercise be imbibed; unless the option of hormone replacement therapy is explored.

Other methods of managing UTIs during menopause include:

• Drinking a lot of water
• Frequent Urination
• Use of Non-steroidal anti-inflammatory drugs
• Use of heating pad

How do you prevent Urinary Tract Infections during Menopause?

Women undergoing menopausal transition may not be able to entirely prevent all urinary tract infections due to the chief underlying cause of UTIs, which is the drop in estrogen and progesterone levels – chiefly the markers of menopause; but they can follow some easy steps to at least reduce frequent recurrences of these UTIs and their associated risks. These steps include:-

• Drinking lots of water and staying hydrated
• Maintaining sex hygiene by urinating after intercourse
• wiping properly after using the toilet and bathroom
• Using showers in place of baths
• Avoiding the use of harsh soaps, deodorants, and creams
• Avoiding douching by all means
• Eating foods that encourage the growth of beneficial microbes (probiotics) like unsweetened yogurt.
• Engaging in simple exercise daily that aims at strengthening the vaginal wall and pelvic floor like long work, yoga, kegel, etc.
• Wear cotton pants and undergarments that allow for air into the vaginal area.

Will Exercises Help with UTIs?

The latest research has linked exercise to one of the ways of managing recurring urinary tract infections. Simple activities like strolling, biking, dancing, etc., have been reported to help prevent microbial infection, especially that of the urinary tracts.

Other exercises like yoga and kegel exercise have also been proven to do wonders in preventing and managing UTIs.

Yoga Exercises

The recent study by UC San Francisco on UTIs prevention using exercise confirmed that different yoga poses could help prevent and manage urinary tract infections by strengthening the pelvic floor muscles and managing urinary and stress incontinence.

Below are a few yoga poses and the benefits of managing the symptoms of urinary tract infections in menopausal women:-

• Chair Pose (Utkatasana)

The chair pose yoga exercise effectively manages involuntary urine leakage from the bladder by helping tighten the bladder muscles and the sphincter.

The chair pose involves standing on the feet hip-width apart and facing forward, and breathing in as you withdraw your face from your palms and move the arms above your head; breathe out and bend your knees and squat down, then move your hips to copy a sitting position like on a chair and then rest your weight on the heels of your feet without lowering your buttocks more than your knees while you the knees pointing forward. Arc the spine by pressing the shoulders down and remaining in that position for about 6 mins; to relax this pose, breathe in and slowly stand up, reaching the arms up while breathing out.

• Triangle Pose (Trikonasana)

The triangle pose is a yoga pose that also manages urinary and stress incontinence as symptoms of urinary tract infections.

The triangle poses, just like the chair pose, involves standing with the feet wide apart such that the legs make a triangle to the floor and then turning the right foot ninety degrees while aligning the right heel with the center of the arc of the left foot and breathing in deeply.

Bend the body to the right from the hip region while breathing out; maintain the position and place the right hand down by the right foot and point the left arm upwards while keeping the back straight; stay put for about 3 to 6 mins while you keep breathing deeply. To relax the body, bring down the arms to the feet sides, slowly straighten the feet, and then stand properly again.

• Squat Pose (Malasana)

The squat pose also manages urinary and stress incontinence and frequent urination. Stand pose is exactly like the chair pose except that, after assuming the sitting position in the air, the hands are brought palm-to-palm to place the elbows at the inner parts of the knee while pushing the elbows more into the knees and opening up the hips the more. Trying to raise the chest slightly towards the sky to stretch the spine. Maintain this position for half a minute or more. To relax, sit on the floor, easily reposition the arms, and stand up.

Consistency with these poses, even for a few minutes daily, according to the report, can also manage pelvic floor inconsistency in addition to their major help on urinary and stress incontinence.

Kegel Exercises

Kegel exercise is excellent in managing the pelvic floor and vaginal wall inconsistencies as symptoms of UTIs. It is recommended that kegel exercises be done a day thrice.

The kegel exercise is simply the tightening of the pelvic muscles by holding tight through the conscious, sucking in the vaginal wall for about 5 seconds, and relaxing the muscles for another 5 seconds while breathing deeply and relaxing the body. This is to be repeated about 10 times for one round; and is to be done for about 3 rounds (3 times) daily.

Be sure not to engage in kegel with a full bladder. Kegel exercise also manages incontinence, but it takes months for the effects to be glaring.

Note: DO not overdo the kegel exercise by forcing a tightening of the muscles as it may become counter-productive; also note that once kegel exercise is halted, symptoms may return, especially for menopausal women.

Can Diet Prevent Or Treat UTIs?

Lifestyle changes have always been of immense importance in managing menopausal symptoms, and the same has been recorded in research for the prevention and management of urinary tract infections. Lifestyle changes like exercise and diet have worked wonders across all health condition management and prevention.

• Berries and other fruits and veggies rich in phytochemicals and phytoestrogen

According to research, fresh juices made from cranberries, lingonberries, strawberries, etc., are very effective against urinary tract infection recurrence since they are rich in flavonoids called epicatechin, which inhibits the binding of the bacteria coliform spp to human cells.

Most plants – fruits and veggies, e.g., apples, plums, cherries, broccoli, spinach, keel, and most cruciferous green veggies are confirmed to have a lot of phytochemicals like quercetin, and flavonoids, although in different concentrations suggesting their effectiveness against bacterial infections as the phytochemicals tend to halt one or two of the microbial growth pathway.

Plants that contain phytoestrogens like soy, flax, etc. have also been suggested to confer protection against bacteria that cause recurring UTIs, especially in menopausal women, as they present the body with natural compounds that mimic estrogen and as well present the roles of estrogen in maintaining reproductive health.

• Fermented Milk and Milk products (Probiotics)

In another study, it has also been confirmed that fermented milk products high in probiotics are also effective against microbial growth, and their consumption has been linked with a reduced incidence of recurring urinary tract infections.

Fermented milk products like cheese, unsweetened yogurt, etc., are rich in probiotics – contain beneficial living microbes in low doses, which form the microfauna and flora of the body, conferring the body with great defense against other harmful microbes; this they sometimes do by simply causing a rise or fall of the vagina or skin pH thereby shutting off other survival conditions of those harmful microbes.   Lactobacilli spp is a good example of these microbes.

A recent study carried out administering Lactobacilli via the consumption of yogurt resulted in the total replacement of Coliform strains by the Lactobacilli strains and also the effectiveness of this Lactobacilli spp against recurring UTIs when administered intra-vaginally and orally as it also restored the pH that favored the natural vaginal microflora in a group of women.

• Vitamins, Minerals, and their supplements

The benefit of vitamins, essential minerals, and supplementations intakes cannot be over-emphasized as their anti-oxidant activities, nerve and muscle toning, helping to mop up oxidants that compromise cell walls and collapse cell functions (oxidative stress) and muscle fibers and neuronal functions, helping with also the maintenance of the pelvic floor and the vaginal wall anatomy thereby providing effectiveness against recurring UTIs.

• Water

Staying hydrated has also been proven to be a lifestyle that helps manage recurring UTIs. Drinking a lot of water helps push out microbes from the urinary tract without allowing them to get to the bladder or giving them ample time to fully colonize the tract before unleashing mayhem on the urinary tract.

Drinking water and staying hydrated also help manage other menopausal symptoms like metabolic disorder and carbohydrate uptake, as water provides the body with optimum conditions for enzyme activation for triggering various biological processes.

Certain foods and beverages have a close association with recurring urinary tract infections and should be avoided in the bid to seek solace in the use of dietary patterns in managing and preventing UTIs. These foods include:

• Soda-based, caffeine-based, and alcoholic beverages are considered bladder irritants and can increase the growth of microbes.
• Sweetened yogurt as they contain lots of added sugar which encourages microbial growth.
• Pork and pork products – pork has been confirmed from research to be a reservoir for many bacterial strains, especially Escherichia coli spp (an intermediate host of many microbes) associated with UTIs.

Although few studies have confirmed to a certain extent that dietary changes may help manage and prevent urinary tract infections and other urogenital dysfunctions, enough research must be carried out to further explain other intricate issues in the dietary management of UTIs.

Summarily, Hormone replacement therapy is very beneficial in managing menopausal symptoms, although factors like age, medical history, and suitable choice are to be considered in other to minimize associated risks and side effects; also, hormone therapy should is not a life-long treatment from menopause onset, and attention should be paid after few years using it in other to know when to start withdrawing and eventually stopping.

Although hormone therapy and certain lifestyle changes may have been proven effective in reducing UTIs recurrence and symptoms; it is still advisable to consult a doctor and get treated for recurring UTIs, and the diets should be aimed at bringing permanent relief and preventing future recurrence as severe and untreated urinary tract infections can aggravate to serious life-threatening complications.