Does vaginal oestrogen therapy do more than just relieve symptoms?
Vaginal oestrogen does more than relieve symptoms: it roughly halves the risk of recurrent urinary tract infections and reduces bladder complaints. Whether it also extends life is unknown; that has never been studied.
Vaginal oestrogen substantially reduces recurrent urinary tract infections. An analysis of five studies shows that women get on average 58% fewer infections compared with placebo. A separate study in more than 5,600 women confirmed this: in the year after being prescribed vaginal oestrogen, women had well over half as many infections.
That benefit is local only. Oestrogen taken as a pill leaves the vaginal environment unchanged and does not reduce infections, as the same analysis of five studies showed. Vaginal application makes the local environment more acidic, which is unfavourable for the bacteria that cause infections.
Not everyone benefits equally. Women aged 75 and older, and women with diabetes, difficulty emptying the bladder, or incontinence, continued to get infections more often despite treatment.
Beyond infection prevention, bladder symptoms also improved: sudden urgency, needing to urinate too frequently, and getting up at night all got better in studies. Stress incontinence improved as well, but that evidence is less strong because those studies lacked a proper comparison group.
There are no data on life extension; no study has ever looked at this. Vaginal oestrogen generally does not raise oestrogen levels in the blood above the normal level seen after menopause. Side effects such as local irritation were not more common with vaginal oestrogen than with placebo in research.
Strength of evidence for preventing urinary tract infections: several studies combined (5 studies) plus a large study following over 5,638 women for years; for bladder symptoms and leaking urine, mainly before-and-after comparisons and several studies combined. No data on death rates or how long women live.
Can estrogen cream help with urinary tract inflammation?
Locally applied oestrogen cream demonstrably reduces the risk of recurrent urinary tract infections in women after the menopause. Oestrogen pills do not help with this; discuss the cream with your doctor if you regularly suffer from bladder infections.
Does hormone therapy help women age more healthily?
Hormone therapy relieves menopausal symptoms well and shows positive indications for bones and metabolism, but the effects on the heart and brain are uncertain and highly individual. Whether it is worthwhile for you depends strongly on your symptoms, timing and health history: discuss it with your doctor.
Do men need estrogen for their health?
Yes, men need oestrogen for strong bones, healthy blood vessels, and fertility. Both a deficiency and an excess are harmful, so it is a matter of finding the right balance.
Is hormone therapy for the menopause safe and worthwhile?
Hormone therapy is worthwhile for menopausal symptoms and bone protection, but safety depends strongly on when you start, which type you use and whether you have a uterus. Discuss the trade-offs with your doctor.
What role do hormones play in mental health complaints?
Hormones, and cortisol in particular, play a demonstrable role in mental health complaints in a proportion of patients, but psychiatry cannot simply use this as a universal explanation. Have your hormone levels measured if you suspect that stress or hormonal dysregulation is contributing to your complaints, and discuss this specifically with your doctor.
Is testosterone important for women?
Testosterone is a physiologically relevant hormone for women, with the strongest evidence for sexual desire and sexual function. If you have symptoms consistent with low testosterone levels, it is worth discussing this with your doctor, including the choice of skin-based delivery.