Cycling, UTIs and Perimenopause: A Physiotherapist Answers the Most Common Questions

February 10, 2026

We spoke with Dr Anna Lowe, chartered physiotherapist, women’s health coach, and founder of Midlife Fitness Coaching, who supports women to stay strong and active through perimenopause and beyond. With a background spanning NHS clinical practice, university-level teaching, and research leadership, Anna combines evidence-led pelvic health expertise with real-world experience as a keen cyclist herself.

1. Can you briefly introduce yourself and your background, and tell us what led you to specialise in women’s and midlife health?

I spent many years working in the NHS supporting people with joint pain, where activity and exercise were a central part of care. During this time, I became increasingly interested in the factors that influence whether someone is able to engage in exercise in the first place.

I later moved into academia and spent several years leading research exploring how we can better support people who face barriers, such as musculoskeletal pain, to engage in exercise and experience the benefits of active living. Through this work, I developed a particular interest in muscle strength and had the privilege of working with brilliant exercise scientists and muscle physiologists on research projects examining the barriers women in midlife face when it comes to strength training.

Women in midlife are significantly underserved by the fitness industry, and much more needs to be done to make health-enhancing interventions, such as muscle strength training, more accessible.

At Midlife Fitness Coaching, we work with busy women aged 40+ who want to improve their health. Midlife brings a unique set of challenges: many women are at the height of their careers, supporting children through the teenage years, while also stepping up support for older relatives. At the same time, women’s bodies change — weight gain, new aches and pains, and increased fatigue are common.

Women’s health shifts during midlife, yet their own needs often fall to the bottom of the list. We help by creating evidence-based, achievable fitness and nutrition plans that support women in finding their way back to health and fitness in a realistic, sustainable way.

I’m a keen recreational cyclist and what I lack in talent, I make up for in enthusiasm! I spend as much time as possible riding bikes — it keeps me fit, helps me manage the stresses and strains of midlife, and is a huge part of my social life too. I’ve also had many, many UTIs over the years, so I’m always mindful of what I can do to reduce the chances of infections.

2. You work with many active, perimenopausal women. What pelvic or intimate health issues do you most commonly see in this group?

It’s incredibly common for women in midlife to experience pelvic health issues, either as a new onset or a worsening of existing symptoms. This is one of the most common concerns we hear about from clients, and it frequently becomes a barrier to exercise.

Stress incontinence is probably the issue women talk about most. It is often normalised as “just part and parcel” of midlife, but we strongly disagree with this idea. Incontinence is incredibly common and usually highly treatable, which is why we always encourage women to speak up and seek the specialist support they need.

Other conditions, such as urge incontinence and pelvic organ prolapse, are also common in women during midlife.

Many women have real concerns about leaking during exercise and worry that physical activity may make their symptoms worse. In reality, staying active and maintaining a healthy weight are both critical in the management of pelvic health issues. It’s therefore really important that we help women find a way forward.

There is still a lot of stigma and embarrassment around these issues, and women are often relieved to share their concerns – and surprised to learn just how common these conditions actually are.

3. From a physiotherapist’s perspective, why can cycling in particular increase the risk of UTIs, irritation, or vulval discomfort? And why are female cyclists more prone to UTIs and vulval irritation?

We don’t have a large body of data to draw on, but there is some evidence suggesting that the incidence of UTIs may be higher in cyclists compared to other populations (Saulicz, M., Saulicz, A., & Saulicz, E.,2024). What we do know is that soft tissue trauma to the genital area is incredibly common in both males and females, and soreness in the saddle area is one of the most frequently reported complaints across all cycling disciplines (Bury, Keira et al.).

When it comes to UTIs specifically, there are several plausible mechanisms that may help explain why female cyclists are more prone to infections and vulval irritation. Maintaining a flexed cycling posture increases intra-abdominal pressure, which in turn increases urethral pressure. Prolonged direct pressure on the genital area, combined with minimal movement, can affect circulation by compressing blood vessels and nerves.

In addition, the chamois (the padding in cycling shorts) creates a warm, moist environment – essentially a “microbial soup” – which may facilitate bacterial growth. Small, repetitive movements can cause chafing and may also assist the transfer of bacteria from the perineal area towards the urethra. These conditions are often sustained for several hours at a time, and consecutive days in the saddle may not allow tissues sufficient time to fully recover between rides.

These factors can be further compounded by dehydration, depending on workout intensity and environmental conditions. Practical issues, such as trail-side wees, may also introduce additional bacteria into the area. The overall picture is one where bacteria may be more abundant, have an environment in which they can thrive, and be more easily transferred – all of which may increase the risk of UTIs and vulval irritation in female cyclists.

4. Are chamois creams and cycling products safe for intimate health?

Most cyclists find that chamois cream is essential. The cream is applied directly to the skin before a ride and creates a barrier that helps protect the skin and lubricate the area, reducing friction and chafing. Everyone has their own preferences, and it’s usually a process of trial and error to find one that suits you.

There are female-specific chamois creams available, and some contain natural antimicrobial agents such as tea tree oil. However, because these products are used regularly and in a sensitive area, it’s important to be mindful of how your skin responds and to choose products that support, rather than disrupt, the delicate balance of the vulval and intimate area – particularly for women who are prone to irritation or recurrent infections.

5. How does perimenopause and declining oestrogen affect tissue quality, resilience, and susceptibility to irritation or infection in the genital area?

Tissue quality changes during perimenopause. Declining oestrogen levels alter the structural integrity of tissues, making them thinner and less resilient. Histological studies show thinning of the epithelial layer, reduced fibroblast activity, decreased collagen and elastin, and reduced vascularity. As a result, the skin simply does not have the same resilience to micro-trauma. These changes also extend to internal structures, including the urethra and vaginal walls (Farage, M., Sharma, K., Wang, Y., et al., 2019).

The changes that occur form part of what is termed the genitourinary syndrome of menopause. This affects many women and can have a significant impact on quality of life, physical health, and relationships (Gass, M., & Portman, D., 2014a).

6. Are there any myths or misunderstandings you often hear from active women when it comes to UTIs, cycling, and pelvic health?

Many of the women we work with are trying to find a way back to fitness, and we support them by creating evidence-based fitness and nutrition programmes that fit into their hectic lives.

Pelvic health issues are incredibly common. From our experience, joint pain and pelvic floor issues are two of the most commonly cited barriers to becoming more active. Many women have stopped, or reduced, exercise due to pelvic floor issues and worry that exercise will make things worse.

Women can feel very alone with these personal issues. The first thing we want women to know is that they are not alone, and that these issues are incredibly common. The second is that they are frequently highly treatable with the right support. The third is that being active and maintaining a healthy weight is important for long-term health, and that there is always a way to be active.

We often use more “creative” programming that takes into account women’s challenges and creates a bespoke way forward.

7. If you could give three practical tips to perimenopausal cyclists who want to stay active without compromising their intimate health, what would they be?

Get the trifecta of shorts, saddle, and chamois cream right. Finding shorts that work for you and have a decent chamois is essential. Saddle comfort is also critical, both for enjoyment and power output. Finding the right saddle as part of a bike fit process can be a real game changer for women. Try different chamois creams and see what works best for you. We always encourage perimenopausal women to have a good conversation with their GP to explore whether HRT may help symptoms. There is compelling evidence that HRT (specifically topical oestrogen) improves tissue quality and reduces UTIs in post menopausal women (Tan-Kim, J., Shah, N. M., Do, D., & Menefee, S. A., 2023).

8. What first interested you in P.Happi®, and where do you see microbiome-friendly products fitting into preventative care for active women?

I was so thrilled to see some innovation in this space. Chiara’s story was incredibly powerful, and as a fellow UTI’er I could really relate to the frustration of yet another infection, as well as the apprehension of future plans being spoiled. It’s brilliant to see a female team of scientists and innovators shaking things up. I will be following their research developments closely and hope that evidence-based, microbiome-friendly products will be more widely available in the future. It makes so much sense to try and move upstream (sorry!) and prevent UTIs from happening in the first place. More preventative options will help women to stay fit and active, improve their long term health and reduce healthcare costs.

For enquiries, you can contact Anna Lowe via IG @midlifefitnesscoaching or LinkedIn www.linkedin.com/in/annalowe1
Website: www.midlifefitnesscoaching.com
Email: coach@midlfiefitnesscoaching.com

References

Saulicz, M., Saulicz, A., & Saulicz, E. (2024). Self-assessment of lower urinary tract condition in female competitive cyclists. Healthcare, 12(12), 1163. https://doi.org/10.3390/healthcare12121163
A Saddle sores among female competitive cyclists: A systematic scoping review
Bury, Keira et al.
Journal of Science and Medicine in Sport, Volume 24, Issue 4, 357 - 367
Farage, M., Sharma, K., Wang, Y., et al. (2019). Histological and Gene Expression Analysis of Menopause Effects. Journal of Clinical Medicine Research, 11(10), 745–759.
Gass, M., & Portman, D. (2014a). Genitourinary syndrome of menopause. Menopause, 21(10), 1063–1068.
Gass, M., & Portman, D. (2014b). Genitourinary syndrome of menopause. Climacteric, 17(5), 557–563.
Tan-Kim, J., Shah, N. M., Do, D., & Menefee, S. A. (2023). Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women. American Journal of Obstetrics and Gynecology, 229(2), 143-e1. https://pubmed.ncbi.nlm.nih.gov/37178856/