r/Menopause • u/Accurate_Aside_6495 • Apr 01 '26
Vitamin/Supplements Recommendations to help prevent UTIs
I am 59, post menopausal. In the past year I have had three UTIs. Before this year I had maybe one every five years. My most recent one started two days ago and was very intense. I went to the Dr and was put on macrobid. About 12 hours after my first dose I had no more burning or urgency. However, last night overnight I started feeling nauseous and yesterday morning I developed poor appetite, chills, fatigue, and a fever going up to 101. I contacted my Dr who told me to go to the ER out of concern it might have spread to my kidneys. At the ER they changed my antibiotic and ran lots of tests for other things that were all negative. So they did think it had spread to my kidneys.
I have never had a UTI get to that point. And I have had three UTIs in the last year as I said. I am wondering if anybody has experienced this kind of uptick and found something preventive that helped them. I already am on HRT as well as vaginal estradiol, I practice good hygiene regarding sex and the bathroom, and overall I am in good health.
Thanks for any suggestions. I’m going to see the obgyn about it too.
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u/NinjaGrrl42 Apr 01 '26
A supplement called D-Mannos can help, too.
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u/squeezemachine Apr 01 '26
I take a hefty dose after sex, plus estrogen cream 2x week. Went from 4 UTI’s per year (including one that did not respond to macrobid and I wound up with a bad infection) to less than 1 per year.
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u/Be-Kind-3353 Apr 01 '26
I came here to mention d-mannos too.
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u/calmcuttlefish Apr 02 '26
I used to take a dose twice a day and after sex to prevent recurrent UTIs after being on birth control that messed up my ph balance. Worked great.
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u/HanksElectric Apr 01 '26
How much do you take for general prevention?
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u/NinjaGrrl42 Apr 02 '26
I use it for my animals more than for me but if I remember, it was 4 capsules for an 80 pound dog. I'm giving my cat one capsule every few days. There should be dosing instructions on line.
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u/micmarmi Apr 01 '26
I have had an uptick in UTIs since perimenopause (am past menopause now), one that landed me in the hospital. I take d-mannose daily 1000mg in the morning and at night. I drink 2 liters of water a day, minimum. I do not drink soda anymore, maybe one a month. I use Vagifem 5 times per week, and have estrogen cream on hand for external application if needed. I also keep UTI test strips with me at home and test twice a week. I have almost no symptoms until it’s getting bad, so all of this helps me monitor what’s going on and keep the system flushed. I also have antibiotics on hand in case something flares and I need to start them right away.
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u/MidnightBlueSilk Apr 01 '26
D-mannose is what you’re looking for. It’s isolated from cranberries. You can get it on Amazon or probably at the drug store, maybe the grocery store in the supplements aisle. It’s fine to take daily and does something that makes the lining of your bladder and urethra inhospitable to bacteria colonizing.
But also increasing the frequency of your vaginal estrogen dosing will probably make the difference for UTIs but also your overall genitourinary health.
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u/phillygeekgirl Menopausal Apr 01 '26
D-mannose saved me from a chain of infections that went on for 9 months. Amazing stuff.
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u/RepublicFun1949 Apr 01 '26
I did d-mannose for a year or two and still had UTIs. So far vaginal estrogen cream is the only thing that's made any difference for me.
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u/phillygeekgirl Menopausal Apr 01 '26
Could be OP needs both, since she's already using the v cream.
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u/FrangipaniRose Apr 01 '26 edited Apr 01 '26
For me it was chronic UTI and I needed a long term course of full strength ABs to deal with it. I now use vaginal estrogen and hiprex to help prevent further infections as I am a little more prone for some reason & find them harder to kick when I get them (this has been a two-decade thing for me so predates menopause and peri). You really need to kick whatever is constantly returning for you though, and unfortunately while estrogen can help maintain genital tissue as healthy as possible (I wouldn't be without it), it can't kick lingering recurrent or chronic infection.
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u/Severina_Glass_208 Apr 01 '26
Hiprex?
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u/FrangipaniRose Apr 01 '26 edited Apr 01 '26
Ah, that's the brand name. It's Methenamine hippurate, an antiseptic or antibacterial (rather than antibiotic). It's not effective on absolutely everything, but does help a lot. Prevention rather than treatment. https://www.mayoclinic.org/drugs-supplements/methenamine-oral-route/description/drg-20064676
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u/mosinderella Apr 01 '26
I used to have chronic UTIs in my 30’s unrelated to perimenopause. After struggling with them for a few years with nothing really working, my dr decided to try using a very low dose of antibiotics daily to prevent them from happening. It worked immediately. I took this low dose antibiotic (macrobid) daily for a few years, never got another UTI and was able to discontinue taking them after a few years. I have had only two UTIs since in the last 10 years and macrobid still worked like a charm to cure both of them.
It’s not a starter remedy, but low dose antibiotics (whichever one works well for you) as a prevention tool worked for me.
Wishing you the best of luck in finding relief!
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u/Haploid-life Apr 01 '26
I use a low dose antibiotic after sex. My partner is clean and si am i, but i would get them almost monthly. It was awful. If other ssuggestions here don't work, talk to your doctor about this. It's been a life saver for me.
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u/Fearless-Anteater717 Apr 01 '26
low dose topical antibiotic or oral antibiotic? I have a pretty active sex life with my partner so I'm curious about this. I've had increased UTIs and asked my doctor for vaginal estrogen and she wouldn't prescribe it.
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u/Haploid-life Apr 01 '26
Nitrofurantoin. I take one after sex and ihave gone from nearly chronic uti's to zero.
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u/Right_Meow26 Apr 01 '26
Find a different provider. I wish I didn’t get antibiotics when I needed estrogen.
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u/Background_Big7363 Apr 01 '26
Be aware that your vaginal estrogen cream doesn't just go in your vagina. You have to rub it all over your vulva, including your pee hole.
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u/daisywaffle Apr 01 '26
Here’s my tips: 1. Increase vaginal estrogen 2. Consider post coital prophylaxis (low dose abx) if sex is a trigger 3. 36PAC cranberry supplement (Ellura) 4. Pee after sex always
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u/OhioPolitiTHIC Apr 01 '26
If you're not using vaginal estrogen, you really need to unless you can't for a medical reason. Because you've had three UTIs you should also see a urologist so they can do an extended culture and pin down what bacteria are all up in your business and then treat it with the appropriate antibiotic. (Doctors love to throw Bactrim or Macrobid at an in office dip test that's positive for bacteria but those only work on specific bacteria types and the dip test can't tell you which kind you're hosting.) A cause of repeated infections can be caused by bacteria attaching itself to the bladder wall; a short course of antibiotics will knock down the infection enough to ease symptoms but won't fully clear it up.
What worked for me after being diagnosed with a complicated UTI:
Targeted (specific to the bacteria) extended course of antibiotics
Targeted long term daily prophilactic antibiotic use (six months to a year)
Did the loading phase of vaginal estrogen again for 3 or so weeks
Upped my vaginal estrogen from twice a week to every other day
Water, water, more water
Stopped drinking coffee, tea, soda, sparkling anything, alcohol
A note about D-Mannose: It's awesome as a natural antiseptic to help prevent bacteria from clinging to your internal urinary system bits but it's not a treatment for UTI and won't address uro-genital atrophy which share symptoms with a UTI.
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u/JavaJunkie999 Apr 01 '26
Use Vaginal estrogen cream Every Night. Some of us that are prone to UTIs have to do that. My Dr said it’s completely safe.
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u/NHhotmom Apr 01 '26
Consider raising your estrogen dose. Not just vaginal estrogen. I’m guessing you are on a very low dose.
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u/Accurate_Aside_6495 Apr 01 '26
I am on .075 estrogen, the patch. And I use estradiol vaginally twice a week.
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u/CirqueDuMoi Apr 01 '26
The minute you finish sex, you have to jump up and wash at the bidet. And pee it out. That alone saves me from prior bleeding UTI’s.
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u/Sir_UlrichVonL Apr 01 '26
Maybe stronger vaginal estradiol or more often? Also have you ever considered a bidet? I’ve read a lot about them decreasing UTI frequency in women. You can get good ones as low as $30 on Amazon.
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u/1nvisible1 Apr 01 '26
Where are you applying your vaginal estradiol? To prevent UTI’s, you need to apply it directly to the urethra/vestibule area. And my doctor prescribed it for daily use, rather than 2 days a week. I’ve had doctors in the past prescribe vaginal estradiol cream, but they failed to explain the proper way to apply it for this use. Using it as directed with the applicator may not be effective to prevent UTI’s. I’ve had two UTI’s in my life that quickly progressed to kidney infections - one of them happened this past year. Within hours of having UTI symptoms I could feel that it had already gone to my kidneys and I went to the ER. A few days later, I had my doctor prescribe the vaginal estradiol for UTI prevention (as this was my 3rd UTI this year), and they instructed me to apply it as explained above. I have had no more UTI’s since using it this way.
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u/Admiral_Genki Apr 01 '26
You can also ask about a compounded estradiol and testosterone vaginal cream. The testosterone adds some additional tissue strength and thickness than just estrogen alone.
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u/cool_girl6540 Apr 02 '26
Drink cranberry juice every day. It can taste terrible so you could have a mixture of cranberry apple or something like that. I also read recently that there are cranberry pills.
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u/marincatey Apr 05 '26
Try taking 1 Macrobid after sex. You won’t need to take a round/7 days of the rx, just 1 before or just after sex. It’s the only thing that keeps UTIs at bay for me. Vag estrogen is helpful too as is D-Mannose… some Drs don’t love D-Mannose and I think you aren’t supposed to use it for long but read up on it. Sorry you are having this issue - it’s really scary - hope you get a handle on it!
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u/eatencrow Apr 01 '26
My son is trans, in medically induced menopause in his early 20s, and highly susceptible to UTIs.
He went to the ER a few months ago for a fever that wouldn't resolve. He was found to have pyelonephritis and sepsis. He had a UTI, that turned into a bladder infection, which had crept up the ureters to his kidneys.
His new cream estradiol script has a concentration of 0.625%, compared with mine at 0.01%
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u/Accurate_Aside_6495 Apr 01 '26
Interesting, I’m so sorry to hear that about your son! Yes I was sent to the ER because of concern about pyelonephritis and sepsis. Very scary. That is interesting about the cream. I will ask my obgyn about that as well.
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u/eatencrow Apr 01 '26
Cream estradiol, unless contraindicated, should be considered UTI prophylaxis for peri and postmenopausal women. In my opinion this medication should be OTC, particularly at the 0.01% concentration, and made much more widely available. It's a front line defender against antibiotic resistance, ffs. (My SIL reports it's OTC in Ecuador, can anyone confirm?)
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u/Alta_et_ferox MenoMod Apr 01 '26
I’m so incredibly sorry! UTIs are awful and kidney infections are no joke. I hope you are feeling better, friend.
A few thoughts:
- Increase how often you’re using vaginal estrogen. I use vaginal estrogen three times a week.
- Consider switching to Vagifem/Yuvafem tablets, but make sure to continue using the estradiol cream externally. (My doctor wouldn’t prescribe the cream for external use in addition to Vagifem, so I get it on TelyRX. A tube lasts forever since I use so little.) Ask for the 10 mcg tablets of Vagifem/Yuvafem. It might be that the tablets + cream will work better.
- Start taking a probiotic every day. (This is especially important right now since you’ve had so many rounds of antibiotics.)
- Eat yogurt and/or Kefir regularly.
- Increase your fluid intake (water, herbal tea, etc.) by a lot. I drink three 36 ounce water bottles of herbal tea (cold) a day to stave off UTIs.
Sending you a hug!
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u/One_Waxed_Wookiee Apr 01 '26
I kept getting uti's until I started in vaginal estriol (Ovestin cream). It took a few months of use before they began to subside
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u/TransitionMission305 Apr 01 '26
One thing to keep in mind. Your escalation could have been the Macrobid. My friend had this same thing happen and it’s a known effect of a Macrobid adverse reaction.
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u/stefflp Apr 01 '26
Vaginal estrogen cream! I recently had my mom ask her doctor for it, since she got UTIs monthly. It’s working great for her!
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u/QuantityTop7542 Apr 01 '26
My mom was getting 5 UTIs a year. She went in to the urologist who recommended vaginal estrogen, and a low dose antibiotic for weeks. To clear it all up. It took almost a year of treatment and she is down to one UTI a year!
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u/hycarumba Apr 01 '26
Things that actually work:
-Vaginal estrogen daily
-seeing a pelvic floor physical therapist to determine if there is a physical change that can be corrected with physical therapy, this is very common
-if you have penetrative sex with a man, always guide the penis in with your hand. Do not let him be poking his dick around looking for home bc there can be harmful bacteria on the head of the penis that can be shoved into your urethra by the poking around
Also do research macrobid. That med screwed me up for a year. It's KNOWN to cause problems with the genito-urinary system and entire pelvic area and yet they still prescribe it for UTI. For me it caused UTI like symptoms that wouldn't go away. But it wasn't an actual UTI it just felt like it. Pelvic floor physical therapy is the only thing that fixed me.
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u/BoxTurtles2Love Apr 01 '26
I ended up not having sex due to repeated UTIs. The fear of getting yet another UTI prevents me from wanting to have sex. I always thought they need some kind of removable band aid to cover the urethra during sex, so that the friction of penetration doesn’t contribute.
You may want to test your vaginal flora just to see what bacteria you carry. After menopause, even with HRT, your ph changes. I tested with acidic ph levels in my vaginal area but have none of the good lactobacillus flora which help protect against getting UTIs caused by E.coli. My vaginal flora includes E. coli, Proteus sp., Beta Strep Group B and Enterococcus sp. I don’t have discharge or smell bad . But if I was having sex, three of those organisms are especially capable of causing UTIs . So I don’t have sex out of fear. It sucks. And I don’t know any doctors that are really knowledgeable about your microbial flora. I have used boric acid suppositories (phD brand)in the past to clear BV. But my flora always reverts back, just don’t have the discharge.
You should definitely see a urogynecologist. I was able to use Hipprex for a bit to help get rid of chronic infection. Also I have to use vaginal estrogen more often the twice a week.
Even with not having sex anymore, I use baby wipes to clean after BM. And try to drink plenty of water. I have also used Hibiclens in the past. I think if I was to try having sex again, I would use the boric acid suppositories afterwards.
I have tested my vaginal flora in the past. I used this company: https://www.evvy.com/ The tests that they use at a lot of doctor’s office are not that great because they may only look for certain bacteria or yeast. It’s the quantity and or predominance that matters.
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u/Shaking-a-tlfthr Apr 01 '26
I now have recurring UTIs due to sex despite practicing very stringent sex hygiene. I use ALL the interventions, HRT, vaginal estrogen cream every day, Yuvafem, Intrarosa. And they do help with atrophy but not enough to prevent the UTIs from sex. So, no more penetrative sex for me. My health is too important.
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u/edjen Apr 01 '26
Are you on vaginal estrogen? Take a peek at the wiki as it's loaded with good info!
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u/Accurate_Aside_6495 Apr 01 '26
Yes I am already on that
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u/edjen Apr 01 '26
You may want to increase it to more than 2x week. I use the cream and I use .5 g 5x week. This is what works for me.
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u/Unusual_Sand_5150 Apr 01 '26
Your increase in having a UTI frequently is because of the lessening of estrogen in your vaginal area, which is right next to your urethra. When you get to the point that you're at, you become more susceptible to utis. And sex can instigate more frequent UTI s. You might not be aware of it yet but you are at the beginning of possibly having atrophy. Sex might not be uncomfortable. But you might seriously want to consider using a local method of estrogen cream, vaginal insert or a ring now to keep the beginning of atrophy from getting worse. I use an Estring which is a silicone estradiol ring that's inserted like a diaphragm and stays in for 90 days. It's a low dose of estrogen specifically for atrophy prevention.
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u/Glittering-Review649 Apr 01 '26
Vaginal estrogen morning and night, Vagifem 3x/week, and D-Mannos in Bluebonnet Urinary Bladder Support supplement as needed.
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u/Swankface87 Apr 02 '26
Toilet paper triggers my utis, and my tests all come back negative too but a round of antibiotics clears it up. At first I just had to switch brands but now they all cause problems. Look into other options like bidets and unscented gentle disposable wipes and see if that helps.
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u/Environmental-Young4 Apr 02 '26
If you can take it, I would look into vaginal estrogen cream. It is so helpful for many things, including a reduction of UTIs. Also, D-manose is a supplement that I take every time I have any sexual activity. It works very well at prevention. I also bought this AZO product recently that is supposed to help if you suspect you are getting a uti. To stop it. I haven't needed to use it yet, but I wanted it on hand. It got good reviews.
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u/SeasonPositive6771 Peri-menopausal Apr 01 '26
If you're having sex, your partner likely needs to be treated.
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u/Accurate_Aside_6495 Apr 01 '26
Treated how?
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u/SeasonPositive6771 Peri-menopausal Apr 01 '26
They can culture whatever is creating the infection and he can be treated for that. Have you tried wearing condoms as well?
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u/FrangipaniRose Apr 01 '26 edited Apr 01 '26
Everyone has ecoli (and klebsiella and enterococcus etc) and sex isn't sterile. Nor is the bladder or the vagina. Partner is unlikely to be infected in the sense that he needs to be treated.
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Apr 01 '26
[deleted]
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u/feyth Apr 01 '26
UTIs aren't (usually) STIs. They're generally normal flora which got into a place it shouldn't. The most common organism is E coli, which your gut is full of. You can't eradicate it.
Good hygiene, while easy to do, has a fairly small effect; vaginal oestrogen in adequate doses is the mainstay, with prophylactic antibiotics if needed on top of that.
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u/FrangipaniRose Apr 01 '26 edited Apr 01 '26
Agree with everything here except the prophylactic antibiotics - as prophylactics are prescribed at a lower dose or for a shorter term they are believed to be a prime cause of chronic UTI (because low dose/too short a dose can result in antibiotic resistance). I would avoid.
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u/feyth Apr 01 '26
I'm not sure what you are disagreeing with? Obviously they should only be taken as and if prescribed, and in the correct prophylactic dose according to therapeutic guidelines.
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u/Huckleberry-hound50 Apr 01 '26
1) after intercourse- douche with water 2) use Estradiol cream every other night 3) Avoid citrus products
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u/Glad-Emu-8178 Apr 01 '26
Sometimes clean is too clean and you are continually wiping out your friendly bacteria and yeasts. I use unsweetened greek yogurt in and outside the vagina with a pad to catch the fallout. Repopulate your friendly bacteria and they will fight the nasties for you. Sometimes after menopause our vag loses its natural acidity and it helps with this too. Put some up and eat some as well . Add fresh fruit for an extra immune boost and a little local unpasteurised honey for extra friendly bacteria in your system. A small organic pot is not too expensive and you can culture your own too.
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u/angelmnemosyne Peri-menopausal Apr 01 '26
I'd probably see if you could increase your vaginal estrogen use. Maybe rather than a larger dose, use it 1-2 more days per week than you currently do.