Why do I get UTIs during my period?
During menstruation, some women are more prone to cystitis, a type of urinary tract infection (UTI) affecting the bladder. Lowering oestrogen when on your period (which has anti-inflammatory properties) can be one cause of cystitis. Other causes include stress, hygiene practices, sex and a lower immunity during menstruation.
5 causes of cystitis during your period
The symptoms of bacterial cystitis, include pain on passing urine, frequency of passing urine, cloudy urine, and sometimes blood in the urine. White blood cells may also be present in high levels.
So, let's have a look at some of the contributing factors:
1. Hormone levels
Oestrogen levels naturally rise and fall throughout our monthly cycle and are lowest during menstruation. Oestrogen has anti-inflammatory properties, so when oestrogen levels are lower we might be more prone to catching a bladder infection. (1)
Women are more prone to UTIs during and after menopause and it is supposed that the drop in oestrogen levels could be the culprit. One study found that in the absence of oestrogen, the good bacteria found in the vagina and urethral tracts, lactobacilli, are not able to survive. E. coli, which is normally present in small amounts can then take over, causing UTIs. (2)
So, it's very possible that we may need some extra support during this time. Targetting any likely hormone imbalances is often a good place to start, or some extra steps to more directly influence the balance of bacteria with the likes of female probiotics may also be helpful.
2. Hygiene practices
I always remember one story from our lovely Siobhan's clinic, where there was a woman with recurrent UTIs, who got them like clockwork around the time of her period. They had tried everything and after months of herbal treatment, she realised that she had been washing her menstrual cup really well but not the small cotton bag that she kept in while she wasn't using it. One quick wash of this bag and she never got a UTI again!
Remember, due to falling hormones, we may be more sensitive than ever to changing bacteria levels during this time.
So, some of the usual advice can be particularly impactful. Such as wiping front to back, as it help prevent the bacteria from our poo getting near our urinary tract. You don't need to take the same care with menstrual blood because it does not contain infection-causing bacteria as poo does, although with the changing hormones during this time we know that the pH of the vagina can risk changing slightly.
But, periods in themselves are not dirty. That notion is definitely a patriarchal concept that we can happily ditch! However, if pads or tampons are not changed regularly, of coruse they could act as a breeding ground for bacteria, which can then make their way up the urinary tract.
So, if you are getting UTIs during your period, try changing your menstrual product as often as every time you pee, or try an alternative product like a menstrual cup, which doesn't harbour bacteria as much. Just make sure you wash it (and the place you store it!) between uses.
Side note: notice that I didn't call them sanitary products or feminine hygiene products... because our periods are not dirty! They don't need sanitising! Let's all ditch those terms too, shall we?
3. Sex
Sex is a common contributing factor when it comes to UTIs. If you are prone to getting UTIs, you've probably heard the advice to pee directly after having sex to avoid an infection.
Some women enjoy having sex during their period and find orgasm to be a helpful remedy for period cramps! If you are having sex during your period this could be a contributing factor though, so it's not that you need to stop, but just understand why this time may make you a little more vulnerable.
4. Immune function
The immune system is naturally suppressed during menstruation so this can mean the bacteria responsible for UTIs have an easier time getting past your natural defences to cause an infection. (3) So, it can be a delicate balancing act between identifying your monthly symptoms which could resemble a cold, or actually residing to the fact that you have actually picked up an infection. I've written a full blog on this topic if you're keen to learn more.
So, again, unsurprisginly, some extra immune support won't normally go amiss during this time. I often recommend stocking up on some immune-supporting remedies like vitamin C and Echinacea, for some extra peace of mind. It may also be worth getting your vitamin D levels checked and, if they are low, take a supplement or get some more sunshine!
5. Stress
Stress reduces immune function and can make us more prone to getting an infection.(4)
In the days leading up to menstruation, and during our menstrual bleed itself, our energy levels naturally decline. Often we crave more alone time and introspection. Yet in this modern world, we are expected to power through, regardless of where we are in our monthly rhythms. This can often lead to symptoms of PMS and higher levels of stress which can, in turn, make way for cystitis or symptoms of UTIs!
If your period is a particularly difficult time for you due to severe PMS or painful cramps (dysmenorrhea), the dread of your upcoming period may also increase your stress levels.
Or, if you suspect an underlying hormone imbalance, could be causing you more stress or troublesome than necessary, a herbal remedy like Agnus castus might be worth looking into; and if you're keen to learn more, I have blog on this topic too, so-called "understanding hormone imbalance."
What can help ease and prevent cystitis?
There are several things which can help prevent or ease cystitis both during your menstrual cycle or any other time, these include:
1. Uva-ursi
Uva-ursi, or bearberry, is a traditional herbal remedy for treating UTIs. It's fast-acting and has an antibacterial effect directly in the urinary tract. Unlike antibiotics, it does not trigger thrush.
The antibiotics properties seem to be due to a compound called arbutin, but as it is a whole plant extract it has lots of other side benefits too rather than side effects. It has astringent properties and contains allantoin which helps to heal inflamed and irritated urinary passages.
It is recommended to take Uva ursi for one week, but symptoms can often start to improve after as little as a few days. However, if symptoms do not improve after the full 7 days, it is important to see your doctor in case something else could be underlying.
2. Echinacea
Echinacea is a great antibacterial and anti-inflammatory herb which is used to treat many infections. It is well known as a remedy for colds and flu but it is also effective in treating urinary tract infections, especially when combined with the herb Uva-ursi, as detailed above.
Echinacea's antibacterial properties help to fight the infection and its anti-inflammatory and immune-supporting properties will help prevent a reoccurrence.
3. Cranberry
A well-known remedy for cystitis, cranberry helps treat UTIs thanks to a compound called D-mannose. D-mannose is a type of sugar molecule which can stop bacteria from sticking to the walls of our bladder and thus prevent them from causing the signs of symptoms of infection. The bacteria are then flushed out with our urine instead of causing any problems.
A Cochrane report concluded that cranberry extract was as effective as antibiotic use in preventing urinary tract infections, without the obvious side effects of regular antibiotic use.(5)
If you are prone to getting a UTI every month with your period it is worth trying some cranberry to prevent reoccurrence.
4. Ditch the coffee
Coffee is a known bladder irritant, so why not swap your coffee out for a nice dandelion or chicory coffee alternative such as our Bambu. These herbal substitutes contain prebiotics good for your digestive tract as well as being a warming and comforting, bladder-friendly coffee alternative!
Can your period irritate your bladder?
Generally, menstruation itself doesn't irritate the bladder, but there are some links due to some of the processes as mentioned above.
However, in conditions like endometriosis, where the endometrial tissue that normally forms inside the uterus also grows in different parts of the body, the bladder can be affected.
Symptoms of endometriosis include severe period cramps and pain during sex; or, if the bladder is affected specifically, pain or burning sensation when urinating, pain when the bladder is full and a feeling of needing to pee all the time. Usually, in bladder endometriosis, these symptoms are all worse during menstruation. If you suspect you might have endometriosis, it is important to speak to your health care provider to get the support you need.
So, if in any doubt, if you have any persistent or extreme symptoms, it's always best to have this checked with your doctor.
Then, for women with interstitial cystitis, menstruation does also seem to increase pain; and while there is some research to back this up, there is still little understanding around this condition and why it flares up at menstruation for some women. (6) Again, it's possible that fluctuating hormones during this time could heighten the inflammatory load on your system.
If your cystitis symptoms are chronic rather than acute and bacterial in nature, which is often the case in cases of interstitial cystitis, it is also worth seeking some extra support from your health care provider.
Then, in the meantime, if you want to learn more about interstitial cystitis you can check out our blog "Interstitial cystitis: Causes, symptoms and possible treatments".
