Recurrent urinary tract infections (UTIs) are often treated as isolated episodes but are we just addressing the ‘Symptom’ rather than the underlying cause?

In older women, recurrent UTIs can be a manifestation of Genitourinary Syndrome of Menopause (GSM), driven by reduced oestrogen levels affecting the urinary, vulval and vaginal tissues. Despite this, many women are repeatedly prescribed antibiotics without tackling the root cause…

This really matters because recurrent UTIs are not just uncomfortable – they can contribute to delirium, functional decline, and, in some cases, lead to serious complications such as sepsis and hospital admissions.

In my role as an NHS GP supporting a large care home, I saw how a proactive approach could make a meaningful difference. During weekly ward rounds, I would routinely ask female residents about symptoms of GSM (e.g. vaginal dryness, recurrent UTIs, and recurrent thrush).

Identifying these symptoms early and considering localised oestrogen therapy where appropriate often helped reduce recurrent genitourinary infections and, importantly, prevented avoidable hospital admissions; which was especially crucial during the COVID-19 pandemic.

Localised oestrogen is available as vaginal pessaries, creams, gels and the Estring. These treatments are simple, safe and effective, with minimal systemic absorption. In fact, using localised oestrogen for a year is roughly equivalent to taking a single 1mg oral oestrogen tablet — making it a very safe option for preventing recurrent UTIs.

If you are experiencing recurrent UTIs or have an elderly mother, sister, or aunt who is, it is worth starting this conversation. Consider asking your/their clinician: “could localised oestrogen be an option?” It may simply help to plant the idea, as it is not always routinely considered.

A simple conversation can make a significant difference…