USA: A new randomised clinical trial suggests that applying oestrogen cream around the urinary opening may be an effective alternative to conventional vaginal application for postmenopausal women who experience recurrent urinary tract infections (UTIs). The findings were published in Obstetrics & Gynecology.
The TAPER trial included 114 postmenopausal participants with laboratory-confirmed recurrent UTIs. They were divided into two groups: one used 1 gram of estradiol cream inside the vagina twice a week, while the other applied a lower 0.5-gram dose around the urethra twice weekly.
Both methods showed similar results
After six months, 50.9% of participants using periurethral oestrogen remained free of UTIs, compared with 52.6% among those using intravaginal oestrogen.
The difference of 1.75 percentage points met the study’s criteria for non-inferiority, indicating that the lower-dose periurethral approach performed similarly to conventional intravaginal application. Researchers also found no meaningful differences between the groups in UTI frequency, time to the first infection, urinary function or sexual function.
Vaginal itching was reported more frequently at three months among participants using intravaginal oestrogen, although other adverse effects did not show significant differences.
Oestrogen may reduce UTI risk after menopause
Recurrent UTIs become more common after menopause partly because declining oestrogen levels can alter the vaginal environment and increase susceptibility to infection. Existing clinical guidance already supports vaginal oestrogen for preventing recurrent UTIs in appropriate postmenopausal patients.
The researchers said the simpler periurethral method could be an alternative for some patients. However, women considering oestrogen treatment should discuss its suitability, benefits and possible risks with a qualified healthcare professional.