Postmenopausal women face a distinct and well-characterised susceptibility to recurrent lower urinary tract infections. This protocol addresses the specific overlap of postmenopausal status, recurrent cystitis, and atrophic vaginitis — a combination that requires a targeted clinical approach.
Postmenopausal women are especially prone to recurrent UTIs due to the increased incidence of atrophic vaginitis and changes in the vaginal microbiome precipitated by lack of estrogenization of the tissues in the vaginal and lower urinary tracts. This creates an environment in which recurrent cystitis becomes a persistent clinical problem requiring a specific management strategy.
When no correctable anatomic issue is identified, the first-line intervention involves a locally applied vaginal estrogen — a well-tolerated, low-risk approach. The specific form used may vary based on patient experience and preference. The complete regimen, preparation selection, and follow-up guidance are available in the full protocol below.
DOI: 10.1053/j.ajkd.2023.08.009
Postmenopausal women are especially prone to recurrent UTIs due to the increased incidence of atrophic vaginitis and changes in the vaginal microbiome precipitated by lack of estrogenization of the tissues in the vaginal and lower urinary tracts.
If there is no correctable anatomic issue, then vaginal estrogens are a well-tolerated, low-risk intervention to undertake.
Vaginal estrogens can be applied in many forms including vaginal rings, creams, and tablets and may take some careful feedback from the patient about her experiences to find the most favorable preparation.
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