Clinical Report: Vaginal Estrogen Prescription and Outcomes in UTI Patients

Overview

An analysis of nearly 1.9 million female patients indicates that vaginal estrogen prescribing following recurrent urinary tract infections is associated with lower rates of sepsis, hospital admission, and all-cause mortality across all age groups.

Background

Recurrent urinary tract infections (rUTIs) are a common issue in postmenopausal women, and current guidelines recommend low-dose vaginal estrogen to prevent these infections. Understanding the impact of vaginal estrogen on rUTIs is critical for improving management strategies in this population.

Data Highlights

Key Findings

• 5.1% of patients with rUTIs received a vaginal estrogen prescription within 2 months of diagnosis.
• Unadjusted rates of sepsis, hospital admission, and all-cause mortality were consistently lower among vaginal estrogen recipients across all age groups.
• Stronger associations for sepsis and death were noted in the 40- to 69-year age groups.
• Baseline comorbidities differed between vaginal estrogen recipients and nonrecipients, with some imbalances noted.
• Only 25% of patients with rUTIs in the broader Cosmos population had ever received a vaginal estrogen prescription.

Clinical Implications

The findings suggest that vaginal estrogen may play a role in reducing serious adverse outcomes in women with recurrent urinary tract infections. Clinicians should consider the potential benefits of vaginal estrogen therapy in accordance with current guidelines to improve patient care.

Conclusion

The study highlights the association between vaginal estrogen use and improved outcomes in women with recurrent urinary tract infections, emphasizing the need for increased awareness and utilization of this therapy.

Related Resources & Content

1. Urology, 2026 -- Vaginal Estrogen Prescription is Associated with Reduced Risk of Serious Adverse Outcomes in Women of All Age Groups with Recurrent Urinary Tract Infections: An Epic Cosmos Database Analysis
2. AUA/CUA/SUFU Guideline, 2025 -- Recurrent Uncomplicated Urinary Tract Infections in Women
3. British Menopause Society, 2025 -- Genitourinary Syndrome of Menopause (GSM)
4. Pain Medicine — Vaginal Estrogen Therapy for Managing Provoked Vestibulodynia in Breast Cancer Survivors: Navigating Risks and Benefits
5. the asco post — Short-Term Vaginal Estrogen Therapy Does Not Increase Risks of Endometrial Cancer Recurrence
6. Frontiers in Immunology — Single-cell and spatial multi-omics reveal estrogen-mediated vaginal wall microenvironment remodeling and a perivascular reparative niche in postmenopausal pelvic organ prolapse
7. The ASCO Post — ‘Paradoxical’ Result Tying Estrogen to Reduced Risk of Breast Cancer Is Consistent with Laboratory Data
8. NICE Guidelines on Recurrent UTI
9. Short-Term Vaginal Estrogen Therapy Does Not Increase Risks of Endometrial Cancer Recurrence
10. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019, Confirmed 2022, Amended 2025)
11. Genitourinary Syndrome of Menopause (GSM) - British Menopause Society
12. Vaginal Estrogen Prescription is Associated with Reduced Risk of Serious Adverse Outcomes in Women of All Age Groups with Recurrent Urinary Tract Infection: An Epic Cosmos Database Analysis - ScienceDirect
13. IP15-36 IMPACT OF VAGINAL ESTROGEN ON SERIOUS ADVERSE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY | Journal of Urology
14. FDA Approves Labeling Changes to Menopausal Hormone Therapy Products | FDA
15. Removal of Black Box Warning Label from Topical Low-Dose Vaginal Estrogen Products
16. Optimizing Sexual Health Care for Cancer Survivors: Evidence-Based Approaches That Respect Patient Autonomy | JCO Oncology Practice