Hormone Replacement Therapy or Prophylaxis in Postmenopausal Women with Recurrent Urinary Tract Infection

Urinary tract infection (UTI) is the most common bacterial infection in women, and it occurs with much greater frequency among elderly than among younger women and with increasing frequency among postmenopausal women. In young to middleage women, the prevalence of UTI is !5%, rising considerably with advancing age. Epidemiologic studies have shown that »15%‐20% of 65- to 70-year old women have bacteriuria, compared with »20%‐50% of women 180 years old [1]. Despite the high prevalence of bacteriuria among postmenopausal women, the factors predisposing such women to UTI have not been explored adequately as compared with those for premenopausal women. However, it has been shown in an epidemiologic and clinical case-control study that nonsecretory status and urologic factors, such as residual volume, reduced urinary flow, previous urogenital surgery, incontinence, and cystocele, are strongly associated with recurrent UTIs in postmenopausal women [2]. Another important factor related to recurrent UTIs is the lack of estrogen, which occurs during menopause, the period starting 1 year after the last menstruation and a time that is expected to encompass one-third of a woman’s life.