‘Heroic’ cranberry juice

Claim four: Cranberry juice is all you need to tackle UTIs in perimenopause

Cranberry juice is routinely recommended on social media as a self-care fix for urinary tract infections (UTIs) – with little acknowledgement of why UTIs become so much more common during perimenopause, or that the management in this patient group may need to differ significantly.

When hormone levels fall during perimenopause and menopause, the urinary tract lining can thin and the body’s ability to fight off bacteria is reduced, increasing the risk of urinary symptoms and recurrent UTIs – leading to an increase in UTIs during the menopause.

Claims about cranberry juice include that cranberry’s active compounds (proanthocyanidins) work by preventing bacteria from adhering to the bladder wall – but this has not translated into consistent clinical trial results for UTI prevention.

“Not only is it unclear whether there is any benefit to drinking cranberry juice for UTIs, but there are actually some good reasons not to,” explains Dr Nisa Aslam, GP and adviser to Effercitrate Tablets, a cystitis symptoms treatment.

Indeed, cranberry juice contains sugar, and a sugar intake will increase UTI risks because excess sugar feeds bacteria in the urinary tract, says the charity Diabetes UK. Certain acidic foods and drinks are also known to irritate the bladder and make it more susceptible to infection.

There are other reasons to be wary of cranberry juice too. “Anyone taking warfarin needs to be cautious of cranberry juice as it can increase its blood-thinning effect, potentially leading to an increased risk of bleeding,” says Dr Aslam.

“Furthermore, people with arthritis, heartburn, irritable bowel syndrome or hiatus hernia should not drink cranberry juice, as this could make symptoms worse. Those with diabetes need to be very cautious of the high levels of sugar in many cranberry juice drinks, too.”

In terms of what actually helps, NICE guidance for people in menopause experiencing genitourinary symptoms and recurrent urinary tract infections is that licensed vaginal oestrogen products should be considered.

Pharmacy teams can help customers to understand the link between falling estrogen and UTI risk, and refer them to the pharmacist, who can assess their suitability for vaginal oestrogen, which has a strong evidence base and is recommended by both NICE and the NHS.