Tuesday, September 10, 2013


Recurrent UTI is one of the most common disease encountered by the urologist in his day to day practice.Most of the women are post menopausal women.It has been proposed that  the oestrogen deficiency leads to depletion of healthy flora of the vagina( lactobacill) and it is replaced by the fecal colonisation.Physiological studies have shown that the oestrogen receptors are present in urethra, trigone, pelvic musculature so post menopausal low oestrogen can lead to genito-urinary atrophy and incontinence.  

Oestrogen deficiency also leads to genitourinary tract atrophy and hence the incidence of UTIs increase in oestrogen depleted states( post menopausal conditions).
Recurrent  UTIs have been defined as more two episodes in 6 months or more than 3 episodes in 1 year.It has been noticed that even after giving a long suppressive dose of antibiotics ; around 60% women face recurrence of UTI aftre the discontinuation of the suppressive antibiotic therapy.
As the underlying atrophic vaginitis and urethritis goes untreated the antibiotic therapy once stopped the bacteria again invade the bladder and urethral mucosa.
Several forms of oestrogen therapy have been advised ; like oestrogen tablets, oestrogen pessary and local oestrogen cream etc. The oral oestrogen administration  has not been found to  be effective rather it can lead to systemic side effects.The local oestrogen therapy is safe as only 1% oestrogen cream goes into the systemic circulation. Oestrogen can lead to cardiovascular events, deep vein thrombosis and breast cancer etc.Still some patients can experience vaginal spotting , breast tenderness etc.But overall these side effects are tolerable.
Apart from preventing recurrent UTI these creams can alleviate the vaginal dryness, vaginal itching and painful sexual intercourse . So quality of life of the patient also can improve.
Local oestrogen cream is the best form of hormone supplementation as it makes the atrophic introitus moist and healthy without systemic side effects.But local oestrogen therapy has not been found to be more effective than low dose suppressive antibiotic therapy.

We in Ramayya Pramila give oestrogen therapy as an adjunct to the low dose suppressive antibiotic therapy.Along with these we give either cranberry or hibiscus extract.  

We ask the patient to use the cream twice a week( some gynecologists/ urologists  ask them to use daily for 21 days followed by a gap of 7 days).
Vaginal products work best if used at bedtime. The hands should first be washed and the applicator filled with cream from the tube. Lying on the back with the knees bent, individuals should insert the applicator into the vagina and push the applicator's plunger to deliver the cream. The applicator and plunger then should be washed with warm, soapy water and rinsed with plain water. The hands should be washed before and after use. A small amount of the cream also can be applied to the outer skin folds or "lips" of the vagina (vulvae) to relieve dryness or irritation.

1 comment:

  1. Thanks for sharing the tips to apply and cure about the oestrogen cream in prevention of recurrent UTIs in postmenopausal women.
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