A new study suggests that older women using topical estrogen to prevent urinary tract infections may still develop one after hip fracture surgery. Researchers found that these women were more than twice as likely to experience a UTI following surgery to repair a broken hip.
The findings, presented at the annual meeting of The Menopause Society, contradict the known benefits of topical estrogen. The treatment is widely used to address vaginal atrophy—a condition caused by low estrogen levels after menopause, which thins and weakens vaginal and urethral tissues. This thinning increases the risk of UTIs by making it easier for bacteria to enter the bladder.
For the study, researchers examined records of 375 women aged 50 and older who underwent hip fracture surgery. Only 9% of them had been using topical estrogen before their injury. Among these users, 36% had a history of recurring UTIs, compared to 13% of non-users. Overall, 26% of all women developed a UTI after surgery.
Women using topical estrogen were 2.5 times more likely to develop a post-surgery UTI, even after accounting for age and prior infection history. The same risk increase applied to women with a history of recurring UTIs, regardless of estrogen use.
The study’s lead researcher, Dr. Jocelyn Wittstein of Duke Health, noted that the low usage of topical estrogen among hip fracture patients was expected. Most users had a history of recurrent UTIs, suggesting they relied on the treatment to manage infections. However, the study raised questions about whether these women continued their therapy consistently after surgery.
Wittstein speculated that noncompliance, skipping doses or stopping treatment, might explain why topical estrogen didn’t reduce UTI risk in this population. She suggested exploring alternative delivery methods, such as vaginal rings that require less frequent application.
Dr. Stephanie Faubion, medical director of The Menopause Society, emphasized that the findings highlight the complexity of treating high-risk patients. While topical estrogen is effective for preventing UTIs in women with vaginal atrophy, its role in reducing perioperative risks remains unclear. She called for further research to determine whether adjusted treatment approaches could help.
The Cleveland Clinic offers additional information on vaginal atrophy.