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Menopausal Hormone Therapy Reduces Urinary Tract Infection Risk

Women who have recurrent infections have fewer types of bacteria in their urine than those who do not have infections.

Nicole De Nisco, PhD

Women who take menopausal hormone therapy may be more resistant to urinary infections.

The findings, presented at the European Association of Urology Virtual Congress, also demonstrated women who suffered from recurrent urine infections had fewer different types of bacteria in their urine than those who did not have infections.

"This study, which evaluates urine microbiome in postmenopausal women, shows that patients with fewer urinary infections tend to have a greater species diversity in their urine. We see more and more evidence that diversity in the microbiome prevents infections. The growth of lactobacillus species is dependent on oestrogen, so oestrogen supplementation may be a helpful therapy in postmenopausal patients," lead study author Nicole De Nisco, PhD, said in a statement.

De Nisco and a team of investigators analyzed bacterial DNA from the urine of 75 postmenopausal women who attended the Urology Clinic at the University of Texas Southwestern Medical Center in Dallas, Texas. The team conducted a controlled, systematic analysis to unpick how the presence of different bacteria was related to recurrent urinary tract infections (UTIs) and susceptibility.

The investigators divided the participants into 3 groups: 25 women who never had a UTI, 25 women who had recurrent infections in the past—defined as at least 3 infections per year—but no current infection, and 25 women who had recurrent infections in the past and were currently infected.

The team found 2 things in the DNA analysis. First, they saw women who had recurrent infections had fewer types of bacteria in their urine than those who did not have infections. In fact, among women who did not have recurrent UTIs, there was 10-times greater variety of bacteria.

Next, the investigative team found among the 34 women taking menopausal hormone therapy, they tended to have more lactobacillus-type bacteria in their urine. The finding could imply oestrogen in menopausal hormone therapy supported the growth of such bacteria in the urogenital tract.

Further, DeNisco and colleagues found women taking menopausal hormone therapy via patches or orally had more lactobacillus than those taking menopausal hormone therapy via vaginal cream.

The findings were important because typically, lactobacilli play a protective role against infections in the vagina and the function may be conserved in the urogenital tract. If such bacteria help with UTIs, a probiotic to use in conjunction with menopausal hormone therapy could help women avoid antibiotic use.

The investigators said due to the small nature of the study, the findings need to be replicated among a larger population of women. More so, the team must perform studies to determine a causal link between oestrogen therapy, lactobacillus colonization, and prevention of UTI.

The study was presented at the 35th European Association of Urology Virtual Conference.