Why do I get cystitis 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)
2. Hygiene practices
I had one client with recurrent UTIs that she got like clockwork with every period for months. We tried everything and after months of herbal treatment at my clinic, 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!
Wiping front to back is a good idea as it prevents 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.
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, they can be a breeding ground for bacteria, which can then make their way up the urinary tract.
If you are getting UTIs during your period, try changing your menstrual product 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?
Sex is a common cause of 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.
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) It can be helpful to take immune-supporting remedies like vitamin C and Echinacea at this time. It may also be worth getting your vitamin D levels checked and, if they are low, take a supplement or get some more sunshine!
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!
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. If this is the case for you, a herbal remedy like Agnus castus might be worth looking into; or you can check out my blog "Does Agnus castus help period pain".
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:
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, and symptoms should improve after just 4 days of use. If symptoms do not improve it is important to see your doctor as a bladder infection can become a kidney infection which can be quite serious.
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. Its antibacterial properties help to fight the infection and its anti-inflammatory and immune-supporting properties will help prevent a reoccurrence.
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.
Ditch the coffee
Coffee is a known bladder irritant, so why not swap your coffee out for a nice dandelion or chicory coffee alternative. 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. 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.
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)
If your cystitis symptoms are chronic rather than acute and bacterial in nature, it is also worth seeking some extra support from your health care provider. If you want to learn more about interstitial cystitis you can check out our blog "Interstitial cystitis: Causes, symptoms and possible treatments".