Changes in hormone levels can impact your chance of getting a urinary tract infection (UTI). Estrogen cream can help with recurrent UTIs in some people by restoring tissue health, balancing vaginal pH, and improving circulation and moisture.

Urinary tract infections occur when microorganisms like bacteria enter your urinary tract and travel up your urethra, the tube that carries urine from the bladder to the outside of your body.

These infections can develop anywhere in the urinary tract, but most often affect the bladder.

You can experience a UTI at any age and for a variety of reasons, but hormone changes are a common cause of recurrent UTIs for many people. As the hormone estrogen declines, as it does during menopause and postmenopause, changes in pelvic tissues can affect urinary health.

UTIs are infections, so it’s natural to feel surprised that hormones like estrogen have anything to do with susceptibility.

Estrogen plays several important roles in the body relative to UTI risk, however, particularly in people with functional ovaries. Estrogen promotes collagen production in pelvic tissues, supports blood flow, and helps maintain bacterial balance. It also influences neurotransmitters involved in bladder sensation and contraction, among other functions.

When estrogen declines, as it does during menopause, or when it’s consistently low, like during the postmenopausal period, tissues in your urinary and reproductive tracts can thin, lose elasticity, and atrophy.

Mucous production also declines, causing dryness. Changes in blood flow can affect muscle strength, and neurotransmitter imbalances can increase the sensation of bladder urgency.

Without enough estrogen, the microbiome of the vagina and bladder can change and affect pH levels, creating an environment where harmful bacteria are more likely to grow.

All of these changes can increase your chance of developing recurrent UTIs.

By administering estrogen therapy through a topical product, you can replenish estrogen levels locally to relieve many of these symptoms.

Applying estrogen cream to the vaginal area can help the tissues of your urethra and bladder, as well.

Estrogen is a fat-soluble molecule. It passes easily through cell membranes and into the bloodstream. Since vaginal tissues are highly vascularized (filled with many blood vessels), estrogen applied in a cream can readily absorb and spread into surrounding tissues like those of the urinary tract.

Your bladder and your urethra have receptors that bind to estrogen as it spreads from vaginal application. Once connected, estrogen activates signaling pathways that influence gene expression to promote proper blood flow, tissue integrity, moisture, and elasticity.

Restoring estrogen locally also helps rebalance the vaginal microbiome, promoting the growth of Lactobacilli bacteria, a microorganism that helps keep vaginal pH low.

According to a 2021 study, local estrogen therapy may also increase Lactobacilli in the bladder microbiome to help improve postmenopausal symptoms of overactive bladder.

Using estrogen cream isn’t a guarantee you’ll never develop a UTI, though it may help reduce your risk for UTI significantly when low estrogen is a factor.

One retrospective review from 2023, for example, found the frequency of UTI decreased by more than 50% for people with estrogen deficiency (hypoestrogenism) using vaginal estrogen for 12 months.

You may still need other UTI treatments and prevention strategies alongside estrogen cream for comprehensive care.

Antibiotics when necessary, proper hydration, urinating after sex, and minimizing douching can all help lower recurrent UTI risk.

Your doctor will go over how to use estrogen cream for your individual needs, and instructions can vary from person to person.

Many estrogen creams come in single-use, disposable applicator tubes intended for insertion into your vagina, but some brands may come as a large tube of cream with a separate applicator that you fill to a specific dose. The package label will indicate how your medication should be used.

General application instructions include:

  • Gently wash the outer parts of your genital area with mild soap and warm water (be sure to rinse well to get rid of soap residue).
  • Do not wash inside of your vagina. The vagina is self-cleaning, and you can disrupt its natural balance, introduce bacteria, and cause irritation with internal washing.
  • Wash your hands thoroughly before opening the applicator tube to reduce the chance of spreading new bacteria.
  • Position yourself comfortably.
  • With your finger, apply a small amount of the estrogen cream to the outer parts of the vagina, if indicated by your doctor.
  • Clean your finger and insert the applicator into your vagina as far as is comfortable.
  • Once in place, press the plunger and empty the applicator completely.
  • Clean or dispose of the applicator as directed on the package insert.
  • Wash your hands thoroughly.

Some estrogen creams may come with a separate tube for external application, or your doctor may recommend using a different applicator for vaginal insertion.

If you’re looking for an alternative to using an applicator, you can apply estrogen cream inside of the vagina using your finger.

  • Wash your hands thoroughly.
  • Apply enough cream to cover half of your index finger.
  • Insert your finger gently, spreading the cream over your urethral opening and just inside of the vagina.
  • Wash your hands with soap and water when done.

Any leakage from the cream can be absorbed with a sanitary pad or liner of your choice.

Estrogen cream isn’t for everyone, and despite being used vaginally, it can cause many of the same systemic risks and side effects of other estrogen replacement therapies.

Common, less serious side effects of estrogen creams can include:

Less common, but serious side effects can include:

Many of the serious side effects from estrogen cream are associated with pre-existing conditions, elevated risk factors, or prolonged use of 4 years or longer.

Estrogen cream can help manage recurrent UTIs, particularly among postmenopausal people. By restoring estrogen to tissues of the urinary and reproductive tracts, circulation, moisture, elasticity, and pH balance can be restored.

Estrogen cream isn’t right for everyone, however, and working closely with your doctor on recurrent UTI management ensures it’s the right choice for you. Anyone can experience recurrent UTIs for many different reasons, and estrogen cream may not be suitable for all circumstances.