New Study: Vaginal Estrogen Can Reduce Death in Women With Recurrent UTIs

Written by Rachel Murphy · July 13, 2026

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Key Takeaways

A recent study of nearly 2 million women found that vaginal estrogen prescriptions were linked to lower risks of sepsis, hospitalization, and death in women with recurrent urinary tract infections (UTIs).

A recent study analyzed data from nearly 2 million women with recurrent urinary tract infections (UTIs), defined as two separate UTIs within one to six months. It found that vaginal estrogen prescriptions were linked to lower risks of sepsis, hospitalization, and death. The study was published in the journal Urology.

UTIs become more common during menopause as estrogen levels drop, explained Dr. Fenwa Milhouse, a urologist and urogynecologist at Down There Urology in Chicago.

Vaginal estrogen is an effective option for preventing recurrent UTIs, and this new study shows it may also lower the risk of related complications.

Key Study Findings

Researchers assessed outcomes for up to eight years among women ages 20 to 99.

Across all age groups, women who were prescribed vaginal estrogen had lower rates of sepsis (a life-threatening complication of infection), hospital admission, and death than women who did not receive a prescription.

The researchers noted that the strongest results were among women ages 40 to 69. This age group, they wrote, “likely represents a higher proportion of women in whom systemic estrogen depletion is a risk factor.”

Among women ages 40 to 54:

Rates of sepsis were roughly 3.25 times higher in women not receiving vaginal estrogen (16.75 percent vs. 5.10 percent).
Rates of hospitalization were approximately twice as high in women not receiving vaginal estrogen (15.73 percent vs. 7.54 percent).
Rates of death were nearly 4.75 times higher in women not receiving vaginal estrogen (3.31 percent vs. 0.70 percent).

Among women ages 55 to 69:

Rates of sepsis were nearly 3.65 times higher in women not receiving vaginal estrogen (24.66 percent vs. 6.77 percent).
Rates of hospitalization were approximately twice as high in women not receiving vaginal estrogen (20.46 percent vs. 10.10 percent).
Rates of death were nearly five times higher in women not receiving vaginal estrogen (7.29 percent vs. 1.51 percent).

Study Limitations

The study authors noted several limitations. The data was deidentified, meaning personal details were removed. The researchers also could not account for factors that were not included in the database, such as income or certain health conditions.

It’s also important to note that the medical records did not show whether the UTIs directly caused sepsis, hospital stays, or death.

How Does Vaginal Estrogen Prevent UTIs?

Estrogen helps keep vaginal bacteria and pH levels balanced. When estrogen levels drop, the risk of UTIs and other vaginal infections may increase.

Lower estrogen levels can also make vaginal tissues thinner and drier, which also leads to “increased propensity or susceptibility to bladder infections or UTIs,” Dr. Milhouse noted.

“When we apply vaginal estrogen, it improves vaginal dryness, and that improves vaginal tissue and reduces the risk of UTIs,” Dr. Milhouse said. “We’re not talking just about convenience with sex. It saves lives as well.”

Dr. Milhouse said these symptoms have a name: genitourinary syndrome of menopause (GSM). It includes vaginal dryness, itching, and painful sex.

GSM is very common during perimenopause and beyond. It affects 50 percent to 90 percent of women in midlife and older, Dr. Milhouse noted. Ongoing use of vaginal estrogen offers a safe and effective way to treat these symptoms.

New Evidence Supports Previous Research

Dr. Rachel Rubin, a urologist and sexual medicine specialist, recently posted about the study on her Instagram page. She pointed to studies going back to 1993 that showed the benefits of vaginal estrogen for women.

She cited a 1993 study in The New England Journal of Medicine that found women treated with vaginal estrogen had about one UTI every two years, compared with about six UTIs a year among women given a placebo (an inactive treatment).

More recently, American Urological Association guidelines recommended low-dose vaginal estrogen for women in perimenopause or after menopause who have recurrent UTIs. The guidelines also say vaginal estrogen may be used by women with GSM who are already using hormone therapy.

How Do You Use Vaginal Estrogen, and When Do You Need It?

Vaginal estrogen comes in several different forms, including creams, dissolvable inserts or suppositories, and rings. How vaginal estrogen is used and how often it is needed depend on the type.

Dr. Milhouse explained that she chooses the type based on factors such as a person’s symptoms, preferences, and insurance coverage.

She also said that vaginal estrogen may be an option for some women with a history of breast cancer.

“Vaginal estrogen is safe even with a history of breast cancer,” she said. “There are multiple studies that found there is no increased risk of breast cancer recurrence or death with vaginal estrogen.”

Always talk to your healthcare team about your health history and risk factors before starting treatment. Women with a history of breast cancer should discuss vaginal estrogen with their oncologist and other healthcare providers.

Women should talk to their doctors about vaginal estrogen if they’ve had any of these symptoms or conditions: