From the Research
Conjugated estrogen is recommended for UTI prevention in postmenopausal women, specifically using vaginal estrogen preparations such as creams, rings, or tablets, as they have been shown to reduce the risk of recurrent UTIs with lower systemic absorption compared to oral estrogen. The most recent and highest quality study, 1, demonstrated that vaginal estrogen therapy can prevent UTIs in postmenopausal women with an active diagnosis of recurrent UTI.
Key Points
- Vaginal estrogen preparations are preferred over oral estrogen due to lower systemic absorption and reduced risk of side effects 2.
- The treatment works by restoring the vaginal epithelium, normalizing vaginal pH, and promoting the growth of beneficial lactobacilli, which helps prevent colonization by uropathogenic bacteria.
- Potential side effects of vaginal estrogen therapy include vaginal discomfort, irritation, burning, and itching, but these are generally mild and well-tolerated 2.
- Women with a concomitant diagnosis of urinary incontinence may be more likely to require additional therapy for UTI prevention 3.
Dosing and Frequency
The optimal dosing and frequency of conjugated estrogen for UTI prevention have not been explicitly stated in the provided studies. However, based on the available evidence, vaginal estrogen preparations are recommended as a first-line therapy for postmenopausal women with recurrent UTIs. The specific dosing and frequency of these preparations may vary depending on the individual patient's needs and medical history.
Patient Evaluation
Before starting treatment with conjugated estrogen, patients should have a thorough evaluation to rule out other causes of recurrent UTIs. This evaluation should include a clinical diagnosis of genitourinary syndrome of menopause (GSM), supported by objective findings such as a vaginal pH >5, decreased content of superficial cells, and/or increased proportion of parabasal cells on vaginal maturation index 4.