It might not be an infection. It might be your hormones.

Your body was fine for thirty years. Then, somewhere in your forties, things change down there — and nobody warned you. It itches. It burns. Sex hurts in a new way. You get a UTI, then another. So you get treated for yeast, or given antibiotics, again and again.

Sometimes that’s right. Often, it’s aimed at the wrong target.

What’s actually going on

Oestrogen keeps the vaginal and urinary tissue thick, elastic and moist, and it feeds the lactobacilli that keep the pH low. As oestrogen falls through perimenopause and after menopause, the tissue gets thinner and drier, the pH rises, and the protective bacteria thin out.

The result has a name — genitourinary syndrome of menopause — and it affects around half of women after menopause. Symptoms include dryness, itching, burning, pain with sex, needing to pee urgently, and recurring UTIs. Unlike hot flushes, it doesn’t fade with time. It tends to get worse without treatment.

Why it gets missed

Because the symptoms overlap almost perfectly with yeast, BV and UTIs, it’s easy to treat each flare as a separate infection. The antifungal or antibiotic helps a bit, briefly — and the underlying change carries on.

What actually helps

• Local (vaginal) oestrogen. A low dose applied directly where it’s needed, as a cream, pessary or ring. It’s one of the most effective treatments for these symptoms, and it can reduce recurring UTIs too — a classic trial showed a dramatic drop in infections. Local oestrogen is a very different thing from systemic hormone therapy; ask about it specifically.
• Vaginal moisturisers used regularly, not just before sex.
• A good lubricant for sex — they do a different job from moisturisers.

If you’re in your forties or beyond and “infections” keep coming back, ask directly: “Could this be hormonal rather than an infection?” It’s a short question that can save years.