What is the evidence for the role of oestrogen in the prevention of recurrent urinary tract infections in postmenopausal women? An evidence-based review

AbstractBackground/PurposeUrinary tract infection (UTI) is the most common bacterial infection in women and increases in frequency post menopause. Falling oestrogen levels after menopause result in urogenital atrophy, which can be effectively treated by topical and oral oestrogen therapy. Oestrogen deficiency also results in alteration in vaginal flora and gram-negative faecal colonisation. Together with atrophic urogenital tissue change, these factors can predispose to ascending UTIs. It is proposed that oestrogen therapy can restore the normal premenopausal vaginal flora and acidic pH and can improve urogenital atrophy, prolapse, and cystocele, thus reducing the recurrence rate of UTIs in postmenopausal women.MethodsA literature search of MEDLINE, EMBASE, PubMed, and CENTRAL was performed for randomised controlled trials in which recurrence of UTI in postmenopausal women for oestrogen versus placebo or other intervention was the primary outcome.ResultsFive clinical trials and two relevant meta-analyses were identified. Oestrogen cream was shown to reduce recurrence of UTI (p