THURSDAY, Oct. 22, 2026 (HealthDay News) — Older women who use topical estrogen to prevent recurrent urinary tract infections might wind up with a UTI anyway after hip fracture surgery, a new study says.
UTIs were more than twice as likely following surgery to mend a broken hip among women who'd previously been using topical estrogen, researchers reported Tuesday at the annual meeting of The Menopause Society.
“We were surprised to see that preoperative vaginal estrogen use did not reduce risk of perioperative UTIs in hip fracture patients,” lead researcher Dr. Jocelyn Wittstein, an orthopedic surgeon at Duke Health in Durham, North Carolina, said in a news release.
Low estrogen levels after menopause can cause the tissues of the vagina and urethra to become thin, dry and fragile, a condition known as vaginal atrophy.
Women with vaginal atrophy have a higher risk of UTIs because thinning tissues make it easier for harmful bacteria to invade the urethra and bladder, researchers said in background notes.
Topical estrogen applied to the vagina as a cream, tablet or time-release ring is a proven and effective treatment to help prevent recurring UTIs in women with vaginal atrophy, researchers said.
However, it wasn’t clear whether this treatment might help lower the risk of UTIs and other complications following surgery, researchers said.
For the new study, researchers analyzed records for 375 women 50 and older who experienced a broken hip and had to have it treated through surgery.
Of the women, fewer than 1 in 10 (9%) had been using topical estrogen prior to their hip fracture. Those using estrogen were more likely to be dealing with recurring UTIs than non-users, 36% versus 13%.
“We were not surprised that utilization was low and mostly in women with history of recurrent UTIs,” Wittstein said of the women using topical estrogen.
About 1 in 4 of all the women (26%) developed a UTI following their hip surgery, researchers found.
Women using estrogen were 2.5 times more likely to develop a UTI after surgery, after accounting for their age and history of recurring UTIs, the study found.
UTIs also were 2.5 times more likely among surgery patients who had a history of recurring UTIs.
“Because we know that vaginal estrogen can prevent UTIs, we suspect the failure to do so in the elderly hip fracture population could be related to noncompliance and that it is currently used primarily in the at-risk UTI patients,” Wittstein said.
In other words, women might not be taking their estrogen as prescribed, leaving the window open for a UTI.
“We need to study different delivery methods; cream, tablets, local estradiol vaginal rings that only have to be changed every three months,” Wittstein said.
Recurring UTIs are common among older women and can lead to worse health problems, said Dr. Stephanie Faubion, medical director of The Menopause Society.
“Although this study identified an association between vaginal estrogen use and perioperative UTIs, it is important to recognize that vaginal estrogen was most often used by women who already had a history of recurrent infections,” Faubion said in a news release. “The findings highlight both the complexity of caring for this high-risk population and the need for additional research to better understand whether vaginal estrogen may have a role in reducing perioperative UTI risk.”
The Menopause Society meeting runs through Saturday in San Diego.
Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
More information
The Cleveland Clinic has more on vaginal atrophy.
SOURCE: The Menopause Society, news release, Oct. 20, 2026
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