Postmenopausal women are disproportionally affected with recurrent UTIs (rUTIs) causing significant morbidity. We aim to emphasize the significance of assessing and managing post-menopausal rUTIs who have been referred to a specialized complex UTI clinic.

Retrospective review of our database to identify postmenopausal women with rUTI referred to our clinic between April 2021 -February 2023.Comprehensive data was gathered, encompassing patient demographics, clinical presentation, frequency of UTIs, hospital admissions, urine culture & Sensitivity, investigations & treatment received prior to and following the referral with treatment response rate. Pre & Post treatment QoL (Quality of Life) & post-treatment PGI-I (Patient global impression of improvement Scale) Score were measured.

123 patients were included with median age of 63.4 years. Mean follow up was 9 months. 65% patients were referred from Primary care &96% had >3 UTIs in 12 months. 6 patients needed hospital admission with urosepsis. 79% patients had E-Coli UTI, sensitive to most antibiotics. Only 9.7% patients had multidrug-resistant bacterial growth. Pre-referral,28% patients received 1st & 2nd line treatment &63% patients reported poor QoL.

In UTI clinic, all patients received advice on cystitis preventive measures.84% patients were managed with combination of 1st & 2nd line treatment including Methenamine Hippurate, prophylactic antibiotics & topical estrogen cream.15% required intravesical instillations to manage refractory UTIs. Flexible Cystoscopy & imaging were abnormal in 16.2% & 5.6% respectively. Post-treatment,96 % reported significant improvement on PGI-I score with Improvement in QoL (p= 0.04).60% had complete UTI resolution. (See Table)

Our results underscore the findings available from the existing literature that post- menopausal women constitute a high-risk group for rUTI that require tailored care1,2,3.Multi drug resistance pattern was not very prevalent in our patient group, suggesting the possibility of inadequate preliminary treatment prior to being referred to our clinic in these women being the cause for the refractory or recurrent episodes. 

 This is supported with the finding that less than 30 percent of the women received first and second-line treatment before being seen in the specialist clinic. This points to a need for improvement in initial management as majority of these patients report a significant decrease in Quality of Life due to rUTI. Simple treatment options in the form of cystitis preventive measures, low dose prophylactic antibiotics and topical oestrogen cream resulted in statistically significant improvement in symptoms and their impact on QoL.

In alignment with results from Perrotta et al, vaginal oestrogen served as a potential management option for rUTI  in our patient cohort. These treatment options are easier to administer, with no limitation or contraindication, to be offered in a primary care setup which can result in reduction of healthcare costs, besides providing faster symptom improvement among post-menopausal women.

Prioritize simple conventional treatment for post-menopausal rUTI before specialist referral

Sanyaolu LN, Cooper E, Read B, Ahmed H, Lecky DM. Impact of Menopausal Status and Recurrent UTIs on Symptoms, Severity, and Daily Life: Findings from an Online Survey of Women Reporting a Recent UTI. Antibiotics (Basel). 2023 Jul 5;12(7):1150. doi: 10.3390/antibiotics12071150. PMID: 37508246; PMCID: PMC10376736.
Rowe, T. A., & Juthani-Mehta, M. (2014). Diagnosis and management of urinary tract infection in older adults. Infectious Disease Clinics of North America, 28, 75–89.
Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005131. doi: 10.1002/14651858.CD005131.pub2. PMID: 18425910.