A. Lenore Ackerman, MD, on vaginal estrogen for recurrent UTIs

The recent amendment to the American Urological Association’s guideline on recurrent uncomplicated urinary tract infections (uUTIs) in women continues to recommend the use of vaginal estrogen for perimenopausal and postmenopausal women with recurrent UTIs.¹ In a recent interview with Urology Times®, guideline amendment chair A. Lenore Ackerman, MD, PhD, discussed how clinicians should approach conversations with patients on the risks and benefits of this therapy.

Ackerman is a urogynecologist at the University of California, Los Angeles.

“I think that the biggest barrier is just educating patients and even some clinicians about the fact that it really is very safe and very effective,” Ackerman explained.

She emphasized that from her perspective, vaginal estrogen seems like “the best of all worlds” since it both avoids the systemic adverse effects and antimicrobial resistance associated with daily antibiotics and supports overall bladder, vaginal, and sexual health in addition to reducing UTI risk.

Ackerman pointed to ACOG’s position statement, including guidance for patients with a history of breast cancer, as a valuable resource to help address misconceptions and increase patient and clinician comfort with its use.

“If [patients are] not willing, it almost always comes down to they are still possessed with fear over some bad data that exists out there,” Ackerman concluded. “The more that we can do as a medical enterprise, as physicians across the country, to really start to alleviate those fears, I think the better our patient's health will be.”

REFERENCE

1. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). American Urological Association. Accessed September 4, 2025. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti