If you seem to get one urinary tract infection (UTI) after another, you are not alone. Recurrent UTIs are especially common in women, and the risk can increase around and after menopause.

A large new study published in Urology suggests that vaginal estrogen may have benefits that go beyond helping prevent repeat UTIs. Researchers found that women with recurrent UTIs who received a prescription for vaginal estrogen had lower rates of serious health problems, including sepsis and hospitalization, compared with women who did not receive a prescription.

While the findings are encouraging, vaginal estrogen is not right for everyone. And because this study was observational, it cannot prove that vaginal estrogen was the reason patients had better outcomes.

Here is what women with recurrent UTIs should know.

What Is a Recurrent UTI?

A UTI occurs when bacteria or other microorganisms infect part of the urinary tract. Some women have infections that keep coming back.

Recurrent UTIs are commonly defined as:

• Two or more UTIs within six months
• Three or more UTIs within one year

Frequent UTIs can interfere with everyday life and, in some cases, can lead to more serious complications such as hospitalization or sepsis.

Why Can UTIs Become More Common After Menopause?

Estrogen levels decline during and after menopause. These hormonal changes can affect the tissues of the vagina and urinary tract.

These changes are part of a condition known as genitourinary syndrome of menopause, or GSM. Symptoms may include vaginal dryness, burning or irritation, pain during sex, urinary urgency or frequency, and recurrent UTIs.

Vaginal estrogen delivers estrogen directly to the vaginal tissues. Research cited in the study suggests that local estrogen can help support the vaginal lining and restore the local environment in ways that may make recurrent UTIs less likely.

What Is Vaginal Estradiol?

Estradiol is one form of estrogen used in vaginal estrogen products. When vaginal estradiol is prescribed, it delivers estrogen locally to vaginal tissues affected by lower estrogen levels.

A health care provider can determine whether vaginal estradiol or another vaginal estrogen product is appropriate based on symptoms, medical history, and treatment goals.

Can Vaginal Estrogen Help Prevent Recurrent UTIs?

Vaginal estrogen is already recommended in clinical guidelines as an option to help reduce recurrent UTIs in appropriate postmenopausal women. Previous research has focused primarily on whether estrogen reduces the number of infections and improves symptoms.

The new study looked at a different question: Were women prescribed vaginal estrogen also less likely to experience serious health outcomes after developing recurrent UTIs?

Researchers analyzed health records from nearly 1.9 million women with recurrent UTIs. About 97,000 had a vaginal estrogen prescription documented within two months of their recurrent UTI diagnosis.

Across the age groups studied, women who received a vaginal estrogen prescription had lower rates of:

• Sepsis
• Hospital admission
• Death from any cause

For example, sepsis occurred in approximately 4% to 10% of women who received a vaginal estrogen prescription, depending on age, compared with approximately 9% to 24% of women who did not. Hospitalization and mortality were also lower in the groups prescribed vaginal estrogen.

Does That Mean Vaginal Estrogen Prevents Sepsis or Death?

Not necessarily.

This study found a strong association between receiving a vaginal estrogen prescription and having fewer serious outcomes. It was not a randomized clinical trial, so researchers cannot say that vaginal estrogen itself caused the difference.

For example, women who received vaginal estrogen may also have been treated by clinicians who recognized recurrent UTI risk earlier, referred patients to specialists sooner, or managed other health conditions more proactively. The researchers were also unable to confirm whether every patient filled or regularly used her prescription.

More research is needed to determine exactly how vaginal estrogen may affect the risk of serious complications.

Is Vaginal Estrogen Only for Women After Menopause?

Most research and current recommendations for preventing recurrent UTIs with vaginal estrogen focus on women after menopause.

Interestingly, the new study found lower rates of serious outcomes among vaginal estrogen recipients in every age group studied, including younger women. However, vaginal estrogen is used much less commonly in younger women and may be prescribed in special circumstances involving low estrogen levels.

The researchers emphasized that more research is needed before drawing conclusions about its role in younger women.

Should I Ask My Health Care Provider About Vaginal Estrogen for Recurrent UTIs?

If you have frequent UTIs, it may be worth discussing vaginal estrogen, including vaginal estradiol, with your health care provider, particularly if you are going through menopause or are postmenopausal.

Your provider can look at your UTI history, symptoms, hormonal status, and overall health and determine whether vaginal estrogen or another prevention strategy may be appropriate.

The bigger message from this research is that recurrent UTIs deserve attention. They are more than an inconvenience, and effective prevention may help reduce both repeated infections and their potential complications.

If UTIs keep coming back, talk with a Urology Health urology or urogynecology specialist about what may be causing them and which prevention options are appropriate for you.

Study Source

LaClair J, Visingardi J, Wells B, et al. 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. Urology. 2026.

This information is intended for general educational purposes and is not a substitute for medical advice. Talk with your health care provider about recurrent UTI prevention and whether vaginal estrogen may be appropriate for you.