Periurethral vs Intravaginal Estrogen for Prevention of Recurrent Urinary Tract Infections

Inclusion Criteria:

• Postmenopausal (definition: No menses for 1 or more years or surgical menopause (bilateral oophorectomy). If there is a past history of hysterectomy, patient mustbe age 56 or older (95th percentile for age at menopause) or have laboratoryevidence of menopause (ie. FSH >30)

• Meets criteria for recurrent urinary tract infections (UTIs) with 2 or more UTI in 6months or 3 or more UTI in 1 year

• May include patients who used vaginal estrogen previously if they have stopped usefor 3 or more months prior to inclusion into study.

• Patients must be recommended vaginal estrogen as part of normal clinical care forprevention of recurrent UTI

Exclusion Criteria:

• Current use of vaginal or oral estrogen products

• Inability or refusal to use vaginal estrogen

• Daily antibiotic use

• Significant vaginal stenosis (eg. due to lichen sclerosis, radiation or obliterativeprolapse surgery) that would prohibit use of a vaginal applicator (ie. genitalhiatus <1cm)

• Inability to use vaginal applicator and without caregiver who can administer (eg.provider-managed pessary use, significant arthritis)

• Frequent (1x weekly or more frequent) use of bladder instillations containing anantibiotic

• Known hydronephrosis as a result of incomplete bladder emptying

• Use of intermittent or indwelling urinary catheterization

• Known bladder stones, mesh erosion into bladder, or foreign object in bladder

• Unable to consent for self

• Active treatment for an estrogen-dependent malignancy