Postmenopausal Hormone Therapy May Help Protect Against Recurrent UTI

By Megan Brooks

July 22, 2020

NEW YORK (Reuters Health) - Older women who take menopausal hormone therapy (MHT) have a greater variety of beneficial bacteria in their urine which may help guard against recurrent urinary tract infections (UTIs), according to research presented July 17 at the European Association of Urology Virtual Congress.

"As far as we know, this is the first focused analysis of the bacteria in the urogenital tract of postmenopausal women, and the results indicate that estrogen use is associated with high levels of Lactobacilli in the urine, which could possibly offer some protection against infection," study presenter Dr. Nicole J. De Nisco, Department of Biological Sciences, University of Texas at Dallas, said in a news release.

Recurrent UTIs are common in postmenopausal women, have a "profound impact on the quality of life" of postmenopausal women and current therapies, namely antibiotics, are failing," Dr. De Nisco, told Reuters Health by email.

"We performed this study to determine if we could leverage some aspect of the recently discovered urinary microbiome to prevent recurrent infections," she said.

The researchers used whole-genome metagenomic sequencing to define and compare genitourinary microbiomes of three groups of postmenopausal women: 25 women who never had a UTI, 25 with recurrent UTIs in the past but no active infection and 25 recurrent UTIs and active infection.

"The DNA analysis showed two things," Dr. De Nisco said in the release. "Firstly, women who have recurrent infections have fewer types of bacteria in their urine than women who do not have infections; women who don't have recurrent UTIs have around x10 greater variety of bacteria. Secondly, 34 of the women were taking MHT, and they tended to have more Lactobacillus-type bacteria in their urine, which may imply that the estrogen in MHT supports the growth of Lactobacillus in the urogenital tract."

Interestingly, Dr De Nisco told Reuters Health, women who were taking MHT via patches or orally had more Lactobacilli than women taking MHT via vaginal cream.

"The finding that urinary Lactobacillus, which is associated with health in the vaginal environment, was strongly associated with particular forms of estrogen hormone therapy (oral and patch) but not vaginal was unexpected," she said.

"This finding fuels even more questions as to why this is the case and what forms of estrogen hormone therapy may be best to prevent recurrent urinary tract infection in postmenopausal women. We are now looking towards clinical trials to test the effectiveness of combining estrogen hormone therapy and probiotic therapies in breaking the cycle of recurrent infection," she added.

Overall, these findings are not surprising, Dr. Stephanie Faubion, medical director for The North American Menopause Society (NAMS), who was not involved in the study, told Reuters Health by email.

"We know that recurrent UTIs are a sign of genitourinary syndrome of menopause (GSM) and that use of HT (systemic and/or vaginal) reduces these symptoms, including risk for UTI. Local vaginal hormonal therapies (estrogens and DHEA) are used to treat urogenital symptoms, including recurrent UTI associated with GSM. These is insufficient evidence to recommend probiotics for treatment of GSM or recurrent UTI," Dr. Faubion said.

SOURCE: European Association of Urology Virtual Congress, presented July 17, 2020.