Q: Are my bladder infections treatable with hormones?

You say you've had itchiness and dryness and get bladder infections fairly regularly. Those symptoms are completely consistent with the absence of circulating estrogen to the genitals. Until recently, this condition would have been called vulvovaginal atrophy; its current name, genitourinary symptom of menopause, does a better job of describing that it affects both the urinary system and the genitals.

Women have estrogen receptors throughout their bodies, but they're most concentrated in the vagina, vulva, and lower urinary tract. In the absence of estrogen, symptoms in that area are more notable. That's the bad news.

The good news is that there are steps we can take to keep our tissues healthy and vital. See our website's suggestions for vaginal comfort, and I encourage women to consider, with their menopause care providers, the use of localized hormones.

Q: How can sex cause urinary symptoms?

The loss of estrogen that comes with menopause results in thinning of urogenital tissues, which include the vagina, vulva, and urethra. Because those tissues are thinner, they can be more fragile and susceptible to "trauma." We don't think of sex as "traumatic," but the activity can cause minor tissue damage.

Sex can also introduce bacteria to the bladder via the urethra, which can lead to bladder infections. And either an infection or the inflammation of damaged tissue can lead to the symptom of urinary urgency.

Using a lubricant during intimacy will minimize the "trauma" to tissues. Emptying the bladder soon after sex may flush out bacteria before they can proliferate and become an infection. (Women with frequent urinary tract infections linked to sex sometimes find it helpful to take a dose of oral antibiotic with sexual activity.) And a therapy like localized estrogen or Osphena may help by restoring proper pH and increasing cell layers.