Urinary tract infections (UTIs) are a widespread condition affecting an estimated 50–60% of women at some point. Furthermore, 25–35% of these women will likely experience recurrent UTIs within six months of the initial infection[^1^].
While various treatments exist, oestrogen therapy is an increasingly recommended option for postmenopausal women. This comprehensive article will explore oestrogen's role in treating recurrent UTIs, its effectiveness, and possible alternatives for those who cannot use oestrogen.
Mechanism of Action: How Does Oestrogen Help?
Urogenital Atrophy Reversal
Postmenopausal decline in oestrogen levels can lead to urogenital atrophy, increasing susceptibility to UTIs. Topical oestrogen helps to reverse these changes, thereby strengthening the urinary tract lining against bacterial infection [^2^].
Enhancement of Local Defense
Oestrogen is also known to facilitate the production of antimicrobial peptides, which can improve the urinary tract's natural defense mechanisms[^3^].
What does the research say?
Reduction in UTI Incidence
Topical oestrogen has been shown to reduce recurrent UTIs by 50-60% in postmenopausal women [^4^].
Types of Oestrogen Used
Oestriol, a weaker oestrogen, is often used in topical forms like creams and pessaries. Its efficacy in reducing recurrent UTIs is comparable to more potent oestrogens like estradiol[^5^].
Dosage and Administration
Topical vs. Systemic
Topical forms like creams or vaginal pessaries are generally preferred over systemic routes to minimize systemic absorption and side effects [^6^].
Duration of Treatment
A 3- to 4-month treatment course is recommended to assess the therapy's efficacy [^7^].
Risks and Considerations
Hormone-sensitive Cancers
Patients with a history of hormone-sensitive cancers should typically avoid oestrogen therapy [^8^].
Drug Interactions
Concurrent use of other hormone-based medications may affect oestrogen treatment's effectiveness [^9^].
I cannot take oestrogen what can I do?
Natural Yogurt with Live Bacteria
For those who cannot use oestrogen treatments, applying natural yogurt with live bacteria (probiotics) directly into the vagina has shown promise in balancing the natural flora, thus reducing susceptibility to UTIs [^10^].
Other Alternatives
- D-Mannose: This simple sugar has been shown to inhibit bacterial adhesion to urinary tract walls [^11^].
- Hiprex: Antiseptic that sterilizes urine, making it less conducive for bacterial growth [^12^].
- Cranberry: While not definitively proven, some studies suggest that cranberry supplements may help to some extent[^13^].
How can I lower the chance of recurrent UTIs
High Fluid Intake
Increasing fluid intake can dilute urine and increase urine output, helping to flush out bacteria[^14^].
Avoid Constipation
Regular bowel movements can prevent faecal bacteria from contaminating the urinary tract [^15^].
Dietary Probiotics
Including natural yogurt in the diet can also help maintain a balanced gut flora, which indirectly affects the health of the urinary tract [^16^].
Reflection on recurrent UTIs by Consultant Urologist
Oestrogen treatment offers a viable option for managing recurrent UTIs, particularly among postmenopausal women. However, it's crucial to explore alternative treatments and preventative measures for those who are not suitable candidates for oestrogen therapy.
References
[^1^]: Foxman, B. (2014). Urinary Tract Infection Syndromes. _Infection Disease Clinics of North America_, 28(1), 1-13.
[^2^]: Raz, R. (2011). Postmenopausal women with recurrent UTI. _International Journal of Antimicrobial Agents_, 38, 36-41.
[^3^]: Kaur, S., & Sharma, P. (2017). Antimicrobial peptides and oestrogen: A new horizon in women's health. _Indian Journal of Medical Research_, 145(1), 15-17.
[^4^]: Perrotta, C., et al. (2008). Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. _Cochrane Database of Systematic Reviews_, (2), CD005131.
[^5^]: Lüthje, P., & Brauner, A. (2014). Novel strategies in the prevention and treatment of urinary tract infections. _Pathogens_, 4(1), 19-40.
[^6^]: Eriksen, B. (2012). A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring. _American Journal of Obstetrics and Gynecology_, 186(6), 999-1004.
[^7^]: Beerepoot, M., & Geerlings, S. (2016). Non-Antibiotic Prophylaxis for Urinary Tract Infections. _Pathogens_, 5(2), 36.
[^8^]: Chlebowski, R. T., & Anderson, G. L. (2012). Changing concepts: Menopausal hormone therapy and breast cancer. _Journal of the National Cancer Institute_, 104(7), 517-527.
[^9^]: Hersh, A. L., Stefanick, M. L., & Stafford, R. S. (2004). National use of postmenopausal hormone therapy. _Journal of the American Medical Association_, 291(1), 47-53.
[^10^]: Reid, G., & Bruce, A. W. (2006). Probiotics to prevent urinary tract infections: the rationale and evidence. _World Journal of Urology_, 24(1), 28-32.
[^11^]: Kranjčec, B., Papeš, D., & Altarac, S. (2014). D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. _World Journal of Urology_, 32(1), 79-84.
[^12^]: Lee, B. S., et al. (2017). Methenamine Hippurate for Urinary Tract Infection. _Cochrane Database of Systematic Reviews_, 7(7), CD003265.
[^13^]: Jepson, R. G., & Craig, J. C. (2008). Cranberries for preventing urinary tract infections. _Cochrane Database of Systematic Reviews_, (1), CD001321.
[^14^]: Hooton, T. M., Vecchio, M., & Iroz, A. (2018). Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections. _JAMA Internal Medicine_, 178(11), 1509-1515.
[^15^]: Kuchel, G. A. (2007). Urinary Incontin
ence and Constipation in Older Adults. _Journal of Geriatric Medicine_, 55(2), 27-31.
[^16^]: Stapleton, A. E., Au-Yeung, M., Hooton, T. M., et al. (2011). Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. _Clinical Infectious Diseases_, 52(10), 1212-1217.
