Adherence to Vaginal Estrogen Therapy in Hypoestrogenic Women With Recurrent Urinary Tract Infections

Exclusion Criteria

• •Have a known etiology of infections (urologic stones, fistulas, fecal incontinence, catheterization, or poorly controlled diabetes - Hgb A1C cutoff of 8)
• •Contraindication to vaginal estrogen (actively treated estrogen-sensitive tumor, allergies to medication formulation, inability to apply or place vaginal estrogen of any modality)
• •Suspected mesh complications or voiding problems from pelvic reconstructive surgery
• •Short vaginal length (less than 7cm) or poor dexterity or mobility that may prevent use of estrogen ring
• •Do not speak English
• •For the nested cohort only - patients currently using vaginal estrogen greater than 2x per month
• •Deferral criteria:
• •Undiagnosed hematuria or vaginal bleeding; however enrollment may proceed after negative workup for malignancy
• •Remote history of estrogen-sensitive tumor: enrollment allowed after approval by oncologist or primary care physician