Vaginal Estradiol Cream and Tablet for Recurrent UTI Prevention in Post-menopausal Women

Study start date: January 12, 2024

Inclusion Criteria: * Women age 20-80 who are post-menopausal or have undergone surgical menopause. Post-menopausal defined as amenorrhea for ≥ 1 year, or surgical menopause through bilateral oophorectomy, or menopausal symptoms for ≥ 1 year in women with prior hysterectomy * New or previous diagnosis of recurrent Urinary Tract Infections (rUTI) (3 or more UTIs in the past year or 2 or more UTIs in the last 6 months) Must have at least one culture documented UTI, the remaining can be documented by urinalysis showing nitrites and leukocyte esterase. * Not currently taking daily prophylactic antibiotics * Willing to use vaginal estrogen for prevention of recurrent UTIs Exclusion Criteria: * Interstitial cystitis or bladder pain syndrome, nephrolithiasis, genitourinary abnormalities, fistula, history of renal transplant or anatomic abnormality of the kidney * Fecal incontinence, intermittent catheterization or indwelling catheter, poorly controlled DM, urothelial cancer, estrogen-sensitive cancer including active breast cancer * Recent urologic surgery within 3 months * Inability to retain vaginal tablet (ex due to advanced prolapse, history of colpocleisis) * Other medical reasons that are deemed incompatible with vaginal estrogen treatment * Use of vaginal estrogen in the past 1 month- patients can be recruited after a 1 month wash-out period * Inability to follow up at clinic study site to give sample, for example due to transportation issues * Organ transplant patients * Patients on systemic hormone replacement therapy (HRT)