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The effect of local estrogen therapy on the urinary microbiome composition of postmenopausal women with and without recurrent urinary tract infections

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Abstract

Introduction and hypothesis

Recurrent urinary tract infections (rUTIs) occur in 2–10% of postmenopausal women. Local estrogen therapy (LET) has been shown to reduce UTIs. This study aimed to compare the urinary microbiome between patients with and without a history of rUTIs and to examine whether treatment with LET influences the diversity and richness of microbiome species in two groups.

Methods

Postmenopausal women with and without rUTIs attending the urogynecology clinic between April 2019 and December 2020 were recruited. Participant baseline characteristics and demographics were recorded. Aseptic transurethral urine samples were collected at recruitment and at 3–6 months following treatment with LET. The V1–V2 and ITS regions of the 16S rRNA gene were sequenced to identify bacteria.

Results

A total of 37 women were recruited, 20 controls and 17 patients with rUTI. During follow-up, symptomatic UTIs occurred in 3/17 (17.6%) and 0/20 in the rUTI group and control group, respectively. Klebsiella aerogenes was present in 80% of rUTI samples and in 53.3% of control samples before LET. Abundance of Finegoldia magna was present in 33.3% of samples before LET, but only in 6.7% after LET. There was no change in relative abundance of lactobacillus species following LET in both groups.

Conclusions

Treatment with vaginal LET altered the local hormonal environment of the urinary bladder and likely protected women from development of rUTI by decreasing the presence of F. magna. To confirm the significance of this bacterial species in rUTI symptomatology, our finding needs to be validated on a larger patient cohort.

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Acknowledgements

The authors thank the study participants and staff of Mount Sinai Hospital’s Urogynecology Clinic for their support. We would also like to thank Microgen personnel Whitney Stanton, Jennifer White and Liz Clines for their assistance with urine processing and microbiome sequencing and Anna Dorogin for technical assistance with urine samples handling.

Funding

International Urogynecology Association 2019 Basic Science Research Grant.

Author information

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada

    Breffini Anglim, Oksana Shynlova & May Alarab

  2. Department of Biological Sciences, Texas Tech University, Lubbock, TX, USA

    Caleb Phillips

  3. Lunenfeld-Tanenbaum Research Institute at Sinai Health System, Toronto, ON, Canada

    Oksana Shynlova & May Alarab

Authors
  1. Breffini Anglim
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  2. Caleb Phillips
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  3. Oksana Shynlova
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  4. May Alarab
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Contributions

B Anglim: project development, patient recruitment, data interpretation, manuscript editing.

C Phillips: data analysis.

O Shynlova: project development, manuscript editing.

M Alarab: project development, patient recruitment, manuscript editing.

Corresponding author

Correspondence to Breffini Anglim.

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Appendix

Appendix

Table 2 Overall test for Hill1 diversity in the recurrent UTI and control groups
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Table 3 ANOVA analysis for Hill1 diversity in the control group
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Table 4 ANOVA analysis for Hill1 diversity in the recurrent UTI group
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Table 5 Overall test for Richness in the recurrent UTI and control groups
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Table 6 ANOVA analysis for Richness in the control group
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Table 7 ANOVA analysis for Richness in the recurrent UTI group
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Table 8 ANOVA analysis for Pielou’s eveness in the control group
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Table 9 ANOVA analysis for Pielou’s eveness in the recurrent UTI group
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Table 10 PERMANOVA analysis for the recurrent UTI group
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Table 11 PERMANOVA analysis for the control group
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Anglim, B., Phillips, C., Shynlova, O. et al. The effect of local estrogen therapy on the urinary microbiome composition of postmenopausal women with and without recurrent urinary tract infections. Int Urogynecol J 33, 2107–2117 (2022). https://doi.org/10.1007/s00192-021-04832-9

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  • DOI: https://doi.org/10.1007/s00192-021-04832-9

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