Estrogen Therapy for UTI's.

Q. I am very concerned about my 82-year-old mother. She is in good health with the exception of osteoporosis and recurrent urinary tract infections. She has been treated for four infections in the last few months. A few years ago, after several courses of antibiotics, she developed jaundice as a result of liver damage from the antibiotics. She is diligent about drinking cranberry juice and lots of water. She has recently been reporting feeling hopeless and depressed due to these recurrent infections. I read recently that estrogen therapy has been found to lower the incidence of UTI's in older women. Is this true?

A. Urinary tract infections are quite common in women. This is mostly due to anatomy and the fact that the female urethra is much shorter than the male urethra. Bacteria from around the anal area can more easily work their way up into the female bladder leading to infection. There are other causes as well, but they are much less common.

Your mom is post-menopausal and therefore, she is estrogen deficient. This often does lead to osteoporosis (thinning of the bones) and atrophy (shrinking) of the urinary and genital cell lining. This can predispose to atrophic vaginitis (inflammation of the vagina), which can lead to urinary incontinence and possibly urinary tract infections.

Studies are inconclusive as to whether or not estrogen treatment can reduce the frequency of urinary tract infections. However, there are several authorities that do believe that topical vaginal estrogen cream can help prevent urinary infections in post-menopausal women (and is helpful to treat atrophic vaginitis).

Also, for women with several urinary infections per year, taking an oral antibiotic such as Bactrim (one tab each day or three times per week) can help prevent urinary infections. Proper hygiene is obviously important including always wiping front to back. Oral estrogen should be considered in your mom's case due to its beneficial effect on osteoporosis. For her depression, I would consider antidepressant therapy (medication and possibly counseling).