Postmenopausal women are often vulnerable to bacterial infections such as UTI. During this stage, falling estrogen levels result in deterioration of the urinary tract and vagina, as well as alteration in vaginal flora (bacteria that live inside the vagina). These changes predispose postmenopausal women to recurrent rate of UTIs. A growing body of scientific evidence indicates that ERT can restore vaginal flora and acidic pH to its premenopausal state, thus reducing the prevalence of UTIs in postmenopausal women:
1. In postmenopausal women with a history of recurrent UTIs, high-dose ERT cures urinary stress and urge incontinence. 
2. In postmenopausal women with urogenital complaints related to estrogen deficiency, low-potency estrogens do not only improve urogenital complaints effectively but also prevent recurrent UTI. 
3. Estrogen prevents UTI by stimulating the proliferation of lactobacillus in the vaginal epithelium, reducing pH, preventing vaginal colonization with Enterobacteriaceae (causative agent of UTI), and maintaining vaginal structure. 
4. In women with atrophic vaginitis (chronic and progressive inflammation of the vagina), use of estriol orally or vaginally is safe and improves urogenital complaints. [344-345]
5. In elderly women, vaginal estrogen treatment for one month dramatically reduces the incidence of UTI by increasing Lactobacilli and restoring vaginal pH. [346-347]
6. In women without liver disease, application of 0.5 mg of estriol cream produces similar beneficial effects with that of oral estriol in treating UTI. [348-349]
7. In menopausal women with recurrent UTI, estrogen stimulates the production of the body’s own antibiotic and strengthens the cells in the urinary tract. 
8. In postmenopausal women with recurrent UTI, use of vaginal estrogen ring for nine months reduces the incidence of UTI by 45%.
9. Oral estrogen administration at a dose of 3 mg of daily for 8 weeks and 1 mg thereafter also reduces the incidence of UTI in postmenopausal women. 
10. In postmenopausal incontinent women, short duration (3-6 months) of ERT has significant benefits on UTI, overactive bladder symptoms, and incontinence. [353-354]
11. In postmenopausal women with recurrent UTI, ERT is more effective than antibiotics at alleviating urinary symptoms. 
12. If administered preoperatively, estrogen can improve outcomes of incontinence repair procedures, thereby preventing UTI. 
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