USA: Researchers have found in new research that among postmenopausal women, application of estrogen cream around the urinary opening (urethra) may be as effective as inserting it vaginally with an applicator for preventing recurrent urinary tract infections (UTIs) over the long term.

The findings, published in Obstetrics & Gynecology by Stephanie W. Zuo of the University of Virginia, Charlottesville, Virginia, and colleagues, suggest that periurethral application of a lower dose of estradiol cream may offer an alternative to conventional intravaginal administration for postmenopausal individuals with recurrent UTIs.
Recurrent UTIs are common after menopause, partly because declining estrogen levels can cause changes in the vaginal and urinary environment that increase susceptibility to infection. Vaginal estrogen is used to help reduce this risk, but the optimal method of applying the treatment has remained uncertain.
The researchers conducted the TAPER (Techniques of Applying Vaginal Estrogen for Prevention of Recurrent Urinary Tract Infections) trial, a single-center, randomized noninferiority study. It included postmenopausal individuals with laboratory-confirmed recurrent UTIs who were assigned to one of two treatment approaches.
One group used 1.0 g of estradiol cream inserted vaginally twice a week with an applicator, while the other applied 0.5 g directly around the urethra using a finger twice weekly. The primary outcome was whether participants remained free of UTIs six months after starting treatment.
Of 270 eligible individuals, 114 were randomized, with 57 assigned to each treatment group. Participants had a mean age of 71.1 years and had experienced a median of three UTIs in the year before enrollment.
The trial revealed the following findings:
  • At 6 months, 50.9% of participants using periurethral estrogen remained UTI-free, compared with 52.6% using intravaginal estrogen.
  • The 1.75-percentage-point difference supported the noninferiority of periurethral estrogen application.
  • Both approaches reduced vaginal pH at 6 months, with reductions of 1.2 with intravaginal and 0.8 with periurethral estrogen; the difference was not statistically significant.
  • Vaginal itching was more common with intravaginal estrogen at 3 months (24.0% vs 2.4%).
  • The groups showed no meaningful differences in UTI frequency, time to first UTI, treatment experience, urinary or sexual function, or other adverse effects.
The researchers concluded that periurethral application of half-dose estradiol cream was noninferior to intravaginal administration for preventing recurrent UTIs in postmenopausal individuals. Both approaches resulted in approximately half of participants remaining UTI-free at six months, suggesting that periurethral application could provide a simpler alternative for some patients.
Reference:
Zuo, S. W., Mowers, E. E., Hem, S., Bradley, M., Zyczynski, H. M., Hillier, S. L., & Ackenbom, M. F. (2026). Vaginal Estrogen Application Techniques for Prevention of Urinary Tract Infection: A Randomized Trial. Obstetrics & Gynecology. https://doi.org/10.1097/AOG.0000000000006376
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Article Source : Obstetrics & Gynecology

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Medha Baranwal

Medha Baranwal holds a Bachelor’s degree in Biomedical Sciences from the University of Delhi and a Master’s degree in Biotechnology from Amity University. Since May 2018, she has been contributing to Medical Dialogues, writing and editing medical news articles that translate complex research into clear, accessible information for healthcare professionals.

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