title: Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors.
abstract: OBJECTIVE
  To assess the effects of hormone therapy on urinary tract infection frequency and to examine potential risk factors.
  
  
  METHODS
  We used data from the Heart and Estrogen/Progestin Replacement Study, a randomized, blinded trial of the effects of hormone therapy on coronary heart disease events among 2763 postmenopausal women aged 44-79 with established coronary heart disease. Participants were randomly assigned to 0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate or placebo and followed for a mean of 4.1 years. History of physician-diagnosed urinary tract infections and risk factors were assessed by self-report at baseline and each annual visit.
  
  
  RESULTS
  Urinary tract infection frequency was higher in the group randomized to hormone treatment, although the difference was not statistically significant (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.99, 1.37). Statistically significant risk factors for urinary tract infections in multivariable analysis included: women with diabetes on treatment (insulin OR 1.81, 95% CI 1.40, 2.34), oral medications OR 1.44, 95% CI 1.09, 1.90), poor health (OR 1.34, 95% CI 1.14, 1.57), childbirth (OR 1.38, 95% CI 1.00, 1.90), vaginal itching (OR 1.63, 95% CI 1.07, 2.50), vaginal dryness (OR 1.30, 95% CI 1.04, 1.67), and urge incontinence (OR 1.51, 95% CI 1.30, 1.75). Urinary tract infections in the previous year were strongly associated with a single urinary tract infection (OR 7.00, 95% CI 5.91, 8.29) as well as multiple urinary tract infections (OR 18.51, 95% CI 14.27, 24.02).
  
  
  CONCLUSIONS
  Oral hormone therapy did not reduce frequency of urinary tract infections. Potentially modifiable risk factors in postmenopausal women are different from those in younger women, and include diabetes, vaginal symptoms, and urge incontinence.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California 94115, USA. brownj@obgyn.ucsf.edu
authors.forename: J S
authors.initials: JS
authors.lastname: Brown
authors.forename: E
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: A M
authors.initials: AM
authors.lastname: Kanaya
authors.forename: S K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: S
authors.initials: S
authors.lastname: Hulley
authors.forename: B
authors.initials: B
authors.lastname: Foxman
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008525:Medroxyprogesterone / Q000008:administration & dosage; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000150:complications; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*
chemical_list: D004966:Estrogens, Conjugated (USP); D008525:Medroxyprogesterone