Have you ever had a urinary tract infection that seemed to clear up, but then it comes right back a few weeks or months later? If so, you are definitely not alone. For many women, recurrent UTIs become an exhausting cycle of discomfort, doctor visits and antibiotics.
Recurrent UTIs aren’t just an inconvenience. In some women, particularly those with other health conditions or vulnerabilities, they can lead to serious complications.
And as women move through perimenopause and menopause, changes in estrogen can make the urinary and vaginal tissues a lot more vulnerable to infection.
I just found a new study involving nearly 1.9 million women that asks a great question: Could vaginal estrogen be associated with a lower risk of serious complications from recurrent UTIs?
The findings are really striking. Women who received a vaginal estrogen prescription had lower rates of sepsis, hospitalization and death than women who did not receive one.
Before we get carried away, however, there’s an important distinction between an encouraging association and proof of cause and effect.
If you want to learn more about menopause and vaginal health tune into the Hack My Age podcast, where I speak with Dr. Anna Cabeca about sexual function, libido, UTIs and vaginal dryness. It’s a great next listen for understanding how hormonal changes can affect your urinary and vaginal health as you age.
When was the study conducted, and who participated?
Published in Urology in 2026, “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” was conducted by Justin LaClair and colleagues using electronic health records from the Epic Cosmos database.
The researchers analyzed 1,891,956 women with recurrent UTIs, defined as two documented infections within one to six months. Of these, 97,109 (5.1%) received a vaginal estrogen prescription within two months of their second documented infection, while the remaining women did not.
Vaginal estrogen delivers estrogen directly to vaginal tissues, helping maintain tissue health and the balance of protective bacteria that can change as estrogen declines during menopause. Researchers wanted to understand whether its use was associated with fewer serious complications and not just fewer recurring infections.
The team tracked outcomes for up to eight years across four age groups, from 20 to 99. Because this was an observational study, the findings reveal associations rather than proving that vaginal estrogen directly caused better outcomes.
What did the researchers find?
The researchers found that vaginal estrogen prescriptions were associated with substantially lower rates of sepsis, hospitalization and all-cause mortality across all four age groups. Here are the reported outcome ranges across the age groups studied:
Sepsis: Among women prescribed vaginal estrogen, rates ranged from 4.2% to 10.4%, compared with 8.5% to 24.1% among women who did not receive a prescription.
Hospital admission: Rates ranged from 7.5% to 12.0% in the vaginal estrogen group, compared with 15.7% to 27.5% in the group without a prescription.
Death from any cause: Rates ranged from 0.3% to 3.9% among women prescribed vaginal estrogen, compared with 0.8% to 9.6% among those who were not.
These are ranges across different age groups, not pooled percentages for the entire study population. The risk of serious outcomes generally increased with age.
The researchers also reported lower odds of each outcome in the vaginal estrogen group across all age groups:
- Sepsis: odds ratios of 0.2–0.5.
- Hospital admission: odds ratios of 0.3–0.6.
- Death from any cause: odds ratios of 0.2–0.4.
An odds ratio compares the odds of an outcome between two groups. An odds ratio below 1 indicates lower odds in the group receiving the prescription. It does not, by itself, prove that treatment caused the difference.
Why is sepsis finding important?
Sepsis is a life-threatening reaction to an infection that can damage organs and requires urgent medical treatment. A urinary tract infection can sometimes progress to a more serious infection, particularly in vulnerable patients.
The lower sepsis rates observed among women prescribed vaginal estrogen are therefore noteworthy. However, this study did not prove that vaginal estrogen directly prevents sepsis.
Did the study prove vaginal estrogen prevents death?
No. It found an association between receiving a vaginal estrogen prescription and lower all-cause mortality; meaning death from any cause, not just death caused by a UTI. The researchers did not establish that vaginal estrogen itself was responsible for the difference.
This distinction matters because women who receive a prescription may differ from those who do not in ways that also influence their health outcomes.
Why might estrogen matter for urinary health after menopause?
Estrogen helps maintain the health of the lower urinary and genital tissues. When estrogen declines, several changes can make recurrent UTIs more likely.
First, vaginal and urethral tissues can become thinner and more fragile. Second, the vaginal pH can rise, making the environment less favorable to certain protective bacteria. Third, the balance of the vaginal microbiome can change.
The microbiome is the community of microorganisms living in and on the body. In a healthy vaginal environment, beneficial bacteria called Lactobacillus help maintain acidity and support the body’s natural defenses. When these protective conditions change, harmful bacteria may find it easier to establish themselves and cause infection.
Vaginal estrogen can help restore aspects of the vaginal environment, including tissue health, acidity and the balance of protective bacteria. This provides a plausible biological explanation for why it may help prevent recurrent UTIs in appropriate patients.
Importantly, this mechanism is not the same as proving that vaginal estrogen prevents sepsis or death. The 2026 study did not directly test those biological pathways.
There is, however, supporting evidence from earlier research. A 2023 review of clinical evidence and a 2021 randomized clinical trial found that vaginal estrogen can help prevent recurrent UTIs in postmenopausal women. These studies support its role in UTI prevention, while the newer database study raises additional questions about potentially more serious outcomes.
What does this mean for women in perimenopause and menopause?
The research reinforces a message I believe women need to hear: urinary health is part of menopause health.
We often associate menopause with hot flashes, sleep disruptions, mood changes and shifts in body composition. Yet changes affecting the vagina, bladder and urethra can also have a meaningful impact on everyday life.
Some women experience dryness or discomfort during sex. Others notice urinary urgency, burning or repeated infections. These symptoms may be mistaken for ordinary aging, or women may assume they simply have to put up with them. Believe me, they don’t have to ignore them.
If you are experiencing recurrent UTIs around menopause, it’s worth asking whether genitourinary syndrome of menopause could be contributing. This does not mean every urinary symptom is caused by estrogen decline, and a clinician should assess possible infections and other causes.
Vaginal estrogen is already an established option for preventing recurrent UTIs in appropriate peri- and postmenopausal women. The new study adds evidence that its potential benefits deserve continued attention.
Individual circumstances matter, including symptoms, medical history, contraindications and personal preferences.
What am I doing about it?
As a gerontologist, I believe we need to take women’s health seriously at every age. Recurrent UTIs, vaginal dryness and urinary changes shouldn’t be dismissed as inevitable parts of getting older.
This research is a reminder to ask better questions, explore evidence-based prevention options and speak openly with healthcare professionals about menopause-related changes. Vaginal estrogen is a cheap and effective solution, but treatment decisions should always be personalized.
My goal is to empower women to make informed choices today that support their health, independence and well-being for years to come. Because caring for your 80-year-old self starts now.
What practical steps can you take to protect your urinary health?
You cannot eliminate every UTI risk, but there are useful steps you can take to recognize problems early and discuss prevention options with your healthcare provider.
1. Track recurring symptoms. Keep a simple record of when symptoms occur, how often infections are diagnosed, what treatments you receive and whether symptoms return.
This can help your clinician identify a pattern and determine whether recurrent UTI prevention is appropriate.
2. Ask whether vaginal estrogen could be suitable for you. If you are in perimenopause or postmenopause and experiencing recurrent UTIs, have a discussion about vaginal estrogen.
Depending on your symptoms and medical history, they may discuss a vaginal cream, tablet, insert or ring. These formulations are not interchangeable in every circumstance, so follow the treatment plan prescribed for you.
Do not start prescription estrogen on your own or assume it is appropriate based solely on this study.
3. Get recurrent infections properly assessed. A clinician may recommend urine testing and, when appropriate, a urine culture to help confirm an infection and identify the bacteria responsible.
Repeated urinary symptoms do not always mean another bacterial infection. Other conditions, including GSM, can produce similar symptoms and may require different treatment.
4. Discuss prevention beyond repeated antibiotics. Depending on your circumstances, your clinician may discuss vaginal estrogen, behavioral measures, methenamine hippurate or antibiotic prevention.
The best option depends on your medical history, infection pattern, preferences and the risks and benefits of each approach.
5. Know when to seek urgent care. Do not wait for a routine appointment if urinary symptoms are accompanied by fever, shaking chills, pain in your back or side, vomiting, confusion or feeling severely unwell. These can be signs of a serious infection and require urgent medical assessment.
Confusion or sudden deterioration in an older or medically vulnerable person deserves particular attention.
6. Keep the evidence in perspective. Hydration, avoiding unnecessary delays in urination and other everyday habits may support general urinary health, but no single lifestyle practice can guarantee that UTIs will not recur.
If infections keep returning, seek an individualized prevention plan rather than relying on supplements or home remedies alone.
What should women take away from this research?
A study of nearly 1.9 million women found that those prescribed vaginal estrogen after recurrent UTIs had lower observed rates of sepsis, hospital admission and death than those who were not prescribed it.
That is a significant finding, but it is not proof that vaginal estrogen directly prevents these outcomes. Differences between the groups, including healthcare access, prescribing decisions and underlying health, may have influenced the results.
The broader evidence already supports vaginal estrogen as an option for preventing recurrent UTIs in peri- and postmenopausal women. This new study adds an important reason to keep investigating its potential benefits.
The message is not that every woman needs estrogen. It is that recurring urinary symptoms deserve attention, menopause-related changes should not be overlooked, and women deserve evidence-based options rather than being told to simply live with the problem.
Your future health is shaped by the questions you ask and the care you receive today.
FAQs: Vaginal Estrogen and UTIs
Can you have a UTI without the usual burning sensation?
Yes. UTIs can cause different symptoms, including frequent urination, urgency, lower abdominal discomfort or changes in how you feel. Some people experience few typical symptoms. Because other conditions can cause similar symptoms, medical assessment may be needed to confirm an infection.
What is the difference between a UTI and genitourinary syndrome of menopause?
A urinary tract infection (UTI) is an infection, usually caused by bacteria entering the urinary tract. Genitourinary syndrome of menopause (GSM) describes vaginal, genital and urinary changes associated with declining estrogen levels. GSM can cause dryness, burning and urinary discomfort that resemble a UTI, and it can also increase susceptibility to recurrent infections.
Can vaginal estrogen be used alongside systemic hormone replacement therapy?
Yes, in some circumstances. A healthcare professional may recommend low-dose vaginal estrogen for persistent vaginal or urinary symptoms even if someone is already using systemic menopausal hormone therapy. Whether additional treatment is appropriate depends on symptoms, medical history and individual needs.
How long does vaginal estrogen take to work?
Improvement is gradual and varies by symptom and formulation. Some women notice changes within a few weeks, while other benefits may take several weeks or longer. Follow the prescribed instructions and ask your healthcare provider when you should expect improvement.
Can vaginal estrogen treat an active UTI?
No. Vaginal estrogen is used to address estrogen-related tissue changes and may help prevent recurrent UTIs in appropriate women. It does not replace medical evaluation or appropriate treatment for an active bacterial infection.
What are the alternatives to vaginal estrogen for preventing recurrent UTIs?
Depending on your circumstances, options may include methenamine hippurate, selected behavioral measures or preventive antibiotics. Your clinician can help determine which strategies are appropriate based on your infection history, medical conditions and preferences. Vaginal moisturizers can relieve dryness but should not be relied on to prevent UTIs.
Is vaginal estrogen safe for women with a history of breast cancer?
The decision requires individualized medical advice. Low-dose vaginal estrogen generally results in less systemic hormone exposure than systemic hormone therapy, but suitability depends on factors such as cancer history, current treatment and individual risk. Women with a history of breast cancer should discuss the potential benefits and risks with their treating clinician, particularly if they take an aromatase inhibitor.
Zora Benhamou is a gerontologist who studies aging and is dedicated to challenging menopause stigma and ageist stereotypes. As the host of the Hack My Age podcast, she focuses on empowering women navigating the menopausal transition through evidence-based techniques that support your 80 year old self.
Reference: LaClair, J., Visingardi, J., Brennan, W., Feustel, P., Deckert, J., & De, E. J. B. (2026). 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, 215, 43–48.