Recurrent urinary tract infections are a problem for many postmenopausal women. Estrogen replacement restores deteriorating mucosa (lining of the vagina), lowers vaginal pH, and may prevent urinary tract infections. Ninety-three postmenopausal women with a history of recurrent urinary tract infections participated in a randomized, double-blind, placebo-controlled trial of a topically applied intravaginal estriol cream. The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo (0.5 vs. 5.9 episodes per patient-year). Lactobacilli (bacteria which are normally present in a healthy vagina and help to keep infection-causing bacteria in check) were absent in all vaginal cultures before treatment and reappeared after one month in 22 of 36 estriol-treated women but in none of the 24 placebo recipients. With estriol, the mean vaginal pH decreased to normal.

To assess the efficacy and safety of intravaginal estriol administration on urinary incontinence, urogenital atrophy, and recurrent urinary tract infections in postmenopausal women, 88 postmenopausal women with urogenital aging symptoms were enrolled in a prospective, randomized, placebo-controlled study. Women in the treatment group  received intravaginal estriol 1 mg once daily for 2 weeks and then 2 mg once weekly for a total of 6 months as maintenance therapy. After therapy, the symptoms and signs of urogenital atrophy significantly improved in the treatment group. 

Younger  women taking oral contraceptives can suffer from similar symptoms. Thirty women (mean age 22.7 years) with a long-standing history of recurrent urinary tract infections received vaginal estrogen therapy consisting of 1mg estriol (E3) daily for two weeks and twice a week for two additional weeks. In the follow-up period of 11 months after treatment, 24 of 30 patients reported no symptoms of bladder infection and used no additional medication. In a majority of young patients using oral contraceptives and a longstanding history of recurrent UTI, a considerable infection-free period was achieved after local  application of estrogen.*

* Eur Urol. 2005 Feb;47(2):243-9

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