The role of estrogen in prevention of recurrent urinary tract infections in postmenopausal women

In the United States, postmenopausal women represent the largest group affected by recurrent urinary tract infections (rUTIs). Limited evidence supports long-term use of antibiotics for rUTI prophylaxis in this population. In addition to being expensive, repeated antibiotic use contributes to antimicrobial resistance, posing additional concerns for postmenopausal women who may be at higher risk for serious infection or complications from resistant infections. Topical estrogen, which directly addresses the pathophysiologic changes associated with rUTIs in this population, offers an effective and cost-efficient option for postmenopausal patients while avoiding the dangers of antimicrobial resistance.