Underdiagnosed and overmedicated: Investigating the management of urinary tract infection and vaginal estrogen use in a large cohort of postmenopausal women.

OBJECTIVE

Genitourinary syndrome of menopause affects 50 %-70 % of postmenopausal women, among whom the diagnosis is presumably based on their age, menopausal status and possible use of vaginal estrogens. It often leads to urinary symptoms resembling urinary tract infections. This study assessed the prevalence of positive urine cultures among postmenopausal women with symptoms of urinary tract infection (such as urgency, frequency, and dysuria), antibiotic acquisition and use of vaginal estrogens.

STUDY DESIGN AND OUTCOME MEASURES: This retrospective cohort study utilized data from the Dan-Petach Tikva district of Clalit Health Services (2019-2022) from 62,813 postmenopausal women aged 55-90 years, of whom 15,242 had symptoms of urinary tract infection. Medical records were reviewed to assess an assumed clinical diagnosis of urinary tract infections based on symptoms, positive urine cultures, and prescription and acquisition records for antibiotics, and vaginal estrogens.

RESULTS

Among 15,242 women (24.3 %) diagnosed with symptoms of urinary tract infection, only 36.2 % had completed a urine culture. Overall, 60.9 % of cultures were positive. Of the women with a positive urine culture, 28 % acquired antibiotics, while 26.2 % of those with negative cultures also acquired antibiotics. Additionally, 11.8 % of the study population used vaginal estrogens, and there was a significantly lower incidence of symptoms of urinary tract infection (11.8 % vs.17.2 %) among these users (p < 0.001).

CONCLUSIONS

These findings highlight antibiotic overuse in cases without confirmed urinary tract infections and the underuse of vaginal estrogen therapy, which may help reduce the incidence of urinary symptoms related to genitourinary syndrome of menopause. These results emphasize the need for improved diagnostic strategies and greater adherence to vaginal estrogen therapy to manage genitourinary syndrome of menopause more effectively and reduce unnecessary antibiotic use.