How Safe Is Vaginal Estrogen Cream to Prevent Urinary Tract Infections?

Many women experience recurrent urinary tract infections (UTIs) that disrupt their lives. Urinary frequency and urgency have them running to the bathroom, but when they get there, urinating is very painful. If the healthcare team cultures the urine, they may find numerous bacteria. That can guide the clinician’s choice of antibiotic. When the situation repeats time after time, though, side effects from antibiotics can start to add up and may even result in a vaginal yeast infection. No wonder women are interested in prevention! One possibility that is frequently suggested is the use of vaginal estrogen cream. Does this help?

Estrogen Cream Stopped Recurrent UTIs

Q. For many years I suffered from urinary tract infections on a regular basis and was told the problem was my hygiene: I wasn’t wiping correctly (in spite of my being very careful). I heard this answer for years, that the infections were my fault.

Finally, in 2019 I had surgery for a complete pelvic prolapse. My surgeon prescribed vaginal estrogen cream (Premarin). When I moved two years ago, my prescription changed to an estradiol cream which I’ve used ever since. And, miraculously, I’ve not had a single UTI in all the years following my surgery. It is such a relief!

A. Recurrent urinary tract infections (UTIs) make some women miserable. This problem is particularly common after menopause.

Vaginal estrogen cream has been recommended for prevention. In one study, more than two-thirds of the postmenopausal women experiencing recurrent UTIs got good relief when they used vaginal estrogen cream (Female Pelvic Medicine & Reconstructive Surgery, March 1, 2021).  An earlier study found that 45 percent of women with recurrent UTIs remained symptom-free for at least nine months while using the Estring vaginal ring. In comparison, only 20 percent of those in the control group escaped a second or third infection (American Journal of Obstetrics and Gynecology, May 1999). Doctors often prescribe the ring for vaginal dryness following menopause.

Is Estrogen Cream Safe to Use for UTI Prevention?

One question many women have considered regarding vaginal estrogen cream is its safety. Years ago, gynecologists and their female patients initially embraced and then resoundingly rejected any form of estrogen therapy. The fear was that estrogen would increase the risk for cardiovascular complications. The prospect of breast cancer was also terrifying.

Fifteen years ago, we received this question and offered the following answer.

Q. I have a lengthy history of urinary tract infections (UTIs) that occur approximately every five months. I have seen a few urologists and had multiple tests, which have all come out normal.

Both my current urologist and my gynecologist are pressuring me to use Premarin vaginal cream to reduce UTIs. Due to the fact that my mother, her sister and my sister have all had breast cancer, I have refused. Last month at my annual exam my gynecologist insisted that the vaginal cream is not absorbed into the blood and will not promote breast cancer. When I mentioned the warnings I’ve seen in pamphlets and on the Internet, my doctor got very angry and said the warnings are for the “old HRT” and do not pertain to the vaginal cream.

I filled the prescription for Premarin cream but found in the literature insert that the top side effect listed is breast cancer. Now I am terribly confused and do not know which path is the correct one.

I have always been told with my family history to avoid all estrogen, even soy products, but I don’t want to be foolish by damaging my health with continual UTIs.

A. Over three decades ago there was evidence that vaginal estrogen cream (Premarin) could be absorbed rapidly and efficiently into the bloodstream (JAMA, Dec. 14, 1979). More recent studies have confirmed that estrogen in vaginal creams or tablets (Vagifem) is readily absorbed into the body (Annals of Oncology, April 2006; Menopause, Jan., 2009, Upsala Journal of Medical Science, 1981). There are concerns that vaginal exposure to estrogen might increase the risk of breast cancer in susceptible women.

2026 Update

In the fall of 2025, the FDA changed its requirements for the warnings on any estrogen prescription. The modifications covered vaginal estrogen cream as well as oral estrogen pills. This did away with the previous boxed warnings about cardiovascular disease, stroke, breast cancer and dementia. Women who have not had hysterectomies still need to be cautious about unopposed estrogen, and we are not sure how vaginal estrogen cream fits into that picture. We were somewhat reassured, however, by an epidemiological study showing that women using vaginal estrogen don’t seem to suffer breast cancer or heart disease at higher than usual levels (Menopause, Dec. 17, 2018). Likewise, a Danish study also failed to find a link between vaginal estrogen (tablets in this case) and breast cancer (BMJ Medicine, Feb. 13, 2024). We hope that future research continues to support the safety of this treatment to prevent recurrent UTIs.