Lower urinary tract infections and the effects of hormone therapy in postmenopausal women in the Zagreb region.

Abstract

Urinary tract infections (UTI) remain one of the most common bacterial infections seen in adult women of all ages. In postmenopausal women, the aging process contributes to local complaints in the lower urogenital tissue, including UTI. Our study was conducted at gynecological practices of the health centers in the Zagreb region, Croatia, during 2009. The study included postmenopausal women with urinary symptoms divided into two groups: hormone therapy (HT) users and controls. The objectives were to estimate microbiologically proven lower UTIs (LUTIs) in postmenopausal women with urinary symptoms and the effect of regular HT use on microbiologically confirmed LUTIs. Out of 2338 postmenopausal patients, there was a significantly higher rate of women with urinary symptoms in HT users, namely 64.4% (143/221), compared to the control group at 4.8% (102/2116). Of the 245 patients with urinary symptoms, in 58.8% (144/245) the infection was microbiologically confirmed. Hormone therapy users showed a statistically significant lower rate of microbiologically proven LUTIs (46.9%, 67/143) compared to controls (75.5%, 77/102, p < 0.001). Data analysis also showed the efficacy of local as well as systemic HT treatment compared with the control group (p < 0.00, p = 0.049). But there was a significant difference in the frequency of LUTIs between patients who used local (30.3%, 20/66) and systemic (61.1%, 47/77) HT (p < 0.001). The patients who, regulary used therapy, in the local HT group as well as in the group on systemic HT showed a lower incidence of LUTIs compared to controls (p < 0.00, p = 0.006). In patients who did not regulary use therapy, there were no significant differences between either local (63.6%, 7/11)) or systemic (76.9%, 20/26) HT non- regular users and the control group (75. 5%, 77/102) (p = 0.917, p = 0.625). The high percentage of patients with non-microbiologically confirmed LUTIs (41.2%, 101/245) suggested the significant role microbiological testing has in LUTI diagnosis. Both local and systemic HT use was related to LUTI reduction.