Vaginal estrogen and risk of hip fracture complications, including perioperative UTIs

by The North American Menopause Society

edited by Swati Mestri, reviewed by Andrew Zinin

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Postmenopausal women are at greater risk for multiple health issues, such as hip fractures and urinary tract infections (UTIs), due to estrogen loss.

Vaginal estrogen is used to prevent recurrent UTIs, but a new study suggests its use may be associated with perioperative hip fracture complications, like UTIs. Results of the study will be presented at the 2026 Annual Meeting of The Menopause Society in San Diego Oct. 20–24, 2026.

Low estrogen levels after menopause cause the tissues of the vagina and urethra to become thin, dry and fragile (vaginal atrophy). Thinning tissues and reduced elasticity make it easier for harmful bacteria to enter the urethra and travel to the bladder, leading to an increase in UTIs.

Vaginal estrogen is an effective treatment option to help prevent recurrent UTIs in postmenopausal and perimenopausal women by rebuilding and thickening the epithelial lining of the vagina and urethra and helping to restore a healthy vaginal microbiome. However, its role in the perioperative setting has not been investigated.

A new study involving 375 postmenopausal women with hip fractures was designed to analyze vaginal estrogen use and its association with perioperative hip fracture complications, including perioperative UTIs. Of the study population, 8.8% (n=33) reported perioperative use of vaginal estrogen. A majority—32 of the 33—had been using vaginal estrogen for at least six weeks before surgery. Nearly 26% of the total (n=94) experienced at least one perioperative UTI, and 28 experienced a preoperative UTI.

A history of recurrent UTIs was present in nearly 15% (n=56) of the study sample and was more common among vaginal estrogen users than nonusers (36.36% vs. 12.90%). In unadjusted analysis, vaginal estrogen use was associated with an increased risk of perioperative UTI. In models adjusted for age and history of recurrent UTI, vaginal estrogen use and a history of recurrent UTI were associated with higher odds of perioperative UTI. However, vaginal estrogen use was not significantly associated with other perioperative hip fracture complications, including emergency department visits, hospital readmission or mortality within a year after surgery.

Based on these results, the researchers concluded that overall use of vaginal estrogen is low in postmenopausal women with hip fractures. In addition, women with a history of recurrent UTIs were more likely to report perioperative vaginal estrogen use and have a perioperative UTI.

The researchers found that vaginal estrogen use was associated with greater risk for perioperative UTI, although vaginal estrogen was most often prescribed to women with recurrent UTIs who are also at increased risk for perioperative UTIs.

The researchers suggested additional investigation to further evaluate the role of vaginal estrogen in perioperative UTI prevention due to the significant morbidity and mortality associated with hip fractures and perioperative UTIs.

"We were surprised to see that preoperative vaginal estrogen use did not reduce the risk of perioperative UTIs in hip fracture patients. We were not surprised that utilization was low and mostly in women with a history of recurrent UTIs. Because we know that vaginal estrogen can prevent UTIs, we suspect the failure to do so in the elderly hip fracture population could be related to noncompliance and that it is currently used primarily in the at-risk UTI patients.

"We need to study different delivery methods: cream, tablets, local estradiol vaginal rings that only have to be changed every three months," says Dr. Jocelyn Wittstein, lead author from Duke Health in Durham, North Carolina.

Details of the study will be discussed as part of the presentation titled "Vaginal Estrogen Use and Perioperative Urinary Tract Infection Rates in Fragility Fracture Patients."

"Recurrent urinary tract infections are common among postmenopausal women and can have serious consequences in older adults, particularly after a hip fracture," says Dr. Stephanie Faubion, medical director for The Menopause Society.

"Although this study identified an association between vaginal estrogen use and perioperative UTIs, it is important to recognize that vaginal estrogen was most often used by women who already had a history of recurrent infections. The findings highlight both the complexity of caring for this high-risk population and the need for additional research to better understand whether vaginal estrogen may have a role in reducing perioperative UTI risk."

Key medical concepts

Recurrent urinary tract infectionsHip Fractures

Clinical categories

Women's healthObstetrics & gynecologyOrthopedicsInfectious diseasesCommon illnesses & PreventionHealthy aging Provided by The North American Menopause Society Who's behind this story?

Swati Mestri

Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

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