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UTIs and Estrogen: the Overlooked Link

By Ashley Winter, MD; Rachel Rubin, MD; and Howie Mell, MD, MPH | on February 16, 2022 | 2 Comments
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References

  1. Chang E, Kent L, Prieto I, et al. Vaginal estrogen as first-line therapy for recurrent urinary tract infections in postmenopausal women and risk factors for needing additional therapy. Female Pelvic Med Reconstr Surg. 2021;27(3):e487-e492.
  2. Portman DJ, Gass MLS, Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):106-1068.
  3. Simon JA, Goldstein I, Kim NN, et al. The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel review. Menopause. 2018;25(7):83-847.
  4. Simon JA, Kokot-Kierepa M, Goldstein J, et al. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause. 2013;20(10):1043-1048.
  5. De Nisco NJ, Neugent M, Mull J, et al. Direct detection of tissue-resident bacteria and chronic inflammation in the bladder wall of postmenopausal women with recurrent urinary tract infection. J Mol Biol. 2019;431(21):4368-4379.
  6. Kingsberg SA, Krychman M, Graham S, et al. The Women’s EMPOWER survey: identifying women’s perceptions on vulvar and vaginal atrophy and its treatment. J Sex Med. 2017;14(3):413-424.
  7. Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU Guideline. J Urol. 2019;202(2):282-289.
  8. Why the product labeling for low-dose vaginal estrogen should be changed. The North American Menopause Society website. Accessed Dec. 30, 2021.
  9. Crandall CJ, Hovey KM, Andrews CA, et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause. 2018;25(1):11-20.
  10. Bhupathiraju SN, Grodstein F, Stampfer MJ, et al. Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause. 2018;26(6):603-610.
  11. Chambers LM, Herrmann A, Michener CM, et al. Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma. Int J Gynecol Cancer. 2020;30(4):515-524.
  12. Manson JE, Goldstein SR, Kagan R, et al. Why the product labeling for low-dose vaginal estrogen should be changed. Menopause. 2014;21(9):911-916.

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Explore This Issue
ACEP Now: Vol 41 – No 02 – February 2022

Pages: 1 2 3 | Single Page

Topics: Antibioticsgenitourinary syndrome of menopause (GSM)hormone therapyUrinary Tract Infectionvaginitis

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2 Responses to “UTIs and Estrogen: the Overlooked Link”

  1. February 21, 2022

    Jon Spangler Reply

    As a 70-year-old man, I have known many women who are post-menopausal and “of a certain age,” including my wife. Urinary tract infections seem to be a common affliction and the authors’ recommendations seem to be simple, effective, and safe.

    I hope this good news can safely and accurately be publicized and the benefits of long-term localized estrogen therapy made widely available.

    Indirectly, this can improve the lives of many men, too, when our sisters, mothers, friends, partners, and spouses are healthier and happier!

    How can we make sure that the word gets out on this good news?

  2. July 8, 2025

    Clare Reply

    I agree I have had a hysterectomy and went into menopause very quickly. I started with lack of collagen and tendonopathy caused by a quick drop in oestrogen which caused inflammation and my body to attack soft tissue. I then had atrophy below and started having UTI infections which came back repeatedly I am now trying vaginal oestrogen now I know the problem. All women especially if they have had a hysterectomy should be offered this earlier as UTI infections are life threatening and very scary when they repeatedly come back. Hope this information helps others.

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