How Estrogen May Help Prevent Urinary Tract Infections After Menopause

Laboratory study suggests vaginal supplementation would benefit some women

By Serena Gordon

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- Estrogen treatment delivered vaginally may help prevent repeat urinary tract infections in postmenopausal women, new laboratory research suggests.

Urinary tract infections are common among women, with one-quarter experiencing recurring infections. And age-related changes increase the likelihood of these infections developing after menopause, when estrogen production plummets.

Until now, taking antibiotics prophylactically -- to ward off recurrent urinary tract infections -- has been the gold standard for these women, said Thomas Hannan, a research instructor in pathology and immunology at Washington University School of Medicine in St. Louis. "But antibiotic resistance is increasing, and some women are resistant to everything we have," Hannan said. "We need other options. We need non-antibiotic options."

This study, published in the June 19 issue of the journal Science Translational Medicine, "suggests a more holistic approach by changing the way women respond to bacteria," said Hannan, co-author of an editorial accompanying the study in the journal.

The results support the use of vaginal estrogen as a preventive measure for postmenopausal women with recurrent urinary tract infections, he wrote in the editorial.

Working in the laboratory and with animal models, the researchers identified a number of ways that estrogen -- the female sex hormone -- helps keep recurrent urinary tract infections at bay.

"This study presents some underlying mechanisms for the beneficial effect of [topical estrogen formulations] after menopause and supports the application of estrogen in postmenopausal women suffering from recurrent UTIs," wrote the study's authors, from the Karolinska Institute in Stockholm, Sweden.

About half of all women will experience at least one urinary tract infection in their lifetime, according to the study. For about 25 percent of these women, the infection will come back again within six months.

Low estrogen levels have previously been linked to recurrent infections, and the new study sought to identify exactly how estrogen might affect a woman's risk of recurrent urinary tract infections.

For the study, the researchers used human cells from postmenopausal women who had used supplemental vaginal estrogen for two weeks. They also worked with mice that were given bacteria that would cause urinary tract infections like those in humans.

They found that estrogen encourages production of natural antimicrobial substances in the bladder. The hormone also makes the urinary tract tissue stronger by closing the gaps between cells that line the bladder. By gluing these gaps together, estrogen makes it harder for bacteria to penetrate the deeper layers of the bladder wall, the study authors said.

Estrogen also helps prevent too many cells from shedding from the top layers of the bladder wall.

"Normally, there's an innate response to infection and some cells die -- sort of taking one for the team -- and then these cells shed," Hannan said. "But shedding too much could allow bacteria to get into the deeper tissue, so this exfoliation is a double-edged sword."

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Can You Skip Antibiotics for Urinary Tract Infection?

In small study, UTI symptoms cleared on their own for most women, but an expert urges caution

By Kathleen Doheny

HealthDay Reporter

TUESDAY, June 4 (HealthDay News) -- Some women with symptoms of a urinary tract infection may be able to skip the antibiotics typically prescribed and have their symptoms improve or clear, according to a new Dutch study.

"In healthy people, many mild infections can be cured spontaneously," said study leader Dr. Bart Knottnerus, a researcher at the Academic Medical Center of the University of Amsterdam.

A U.S. expert, however, had a number of cautions about the findings, including the small number of women studied.

For the research, published May 31 in the journal BMC Family Practice, Knottnerus recruited women from 20 general medical practices in and around the Netherlands from 2006 to 2008. Women who had contacted their doctor complaining of frequent urination, painful urination or both were asked if they would be willing to delay antibiotics -- but only if their symptoms had been present for no longer than seven days.

Certain women were excluded, including those pregnant or breast-feeding or those whose immune systems were compromised.

In all, 176 women participated. Of those, 137 were asked to delay antibiotics and 51 agreed. All the women gave a urine sample to be analyzed and cultured. The women reported on their symptoms over the next week.

After a week, 28 of the 51 women willing to delay antibiotic use still had not used an antibiotic. Twenty of these women (71 percent) reported disappearance or improvement of their symptoms. Of these 20, more than a third had a positive culture result, indicating an infection. The researchers did not know the culture results at the start of the study.

Most of the women not willing to delay antibiotics had a positive culture.

The women who did agree to delay, Knottnerus said, might be aware of the bacterial resistance that can result from antibiotic use. "Furthermore," he said, "in the Netherlands, other mild infections -- like eye, ear, throat and respiratory infections -- are usually not treated with antibiotics. Therefore, people might be more receptive to delayed antibiotic prescriptions."

Antibiotics for urinary tract infections usually work within two or three days. How would an infection clear on its own? "Our defense mechanisms are strong and often do not need any help from antibiotics," Knottnerus said. He studied only uncomplicated infections of the bladder -- defined as those in healthy, non-pregnant women.

Dr. Jennifer Leighdon Wu, a gynecologist at Lenox Hill Hospital in New York City, was cautious about the findings. "The number of women who agreed to delay was 51," she said. "Before changing my practice, I would like to see much larger numbers."

Checking in with your doctor might uncover some other problem, she said. "I can't tell you how many people have come in thinking it's a urinary tract infection and it's a yeast infection," she said.

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