Introduction: Estrogen deficiency after menopause is an important predisposing factor for recurrent UTI (r UTI). Vaginal application of estrogen as “hormone replacement therapy (eHRT)” for prevention of menopause associated r UTI has moderate recommendation and evidence level grade B by AUA/CUA/SUFU guidelines 2019. Glycosuria with use of SGLT 2I among T2DM, increase risk of r UTI by 4-9%. SGLT2 I use among T2DM, post-menopausal females may further increase risk of r UTI.

Aim and Objective: This study was designed to observe (1) the Risk and frequency of UTI due to SGLT2 I among post-menopausal females with T2DM and (2) Preventive effect of vaginal e HRT for r UTI among them.

Methods: Forty-two, post-menopausal females having T2DM, using vaginal e HRT were selected as cases whereas controls were 38 matched females not using e HRT. Subjects in both groups were prescribed SGLT2 I considering eligibility and simultaneously adjusted the doses of other OHA’s or insulin to maintain the glycemic targets. They were targeted to follow for 12 months and evaluated periodically for symptomatic UTI and maintenance of glycemic targets. Diagnosis of symptomatic UTI was made using standard definition and guidelines.

Result: The 42 cases who were using vaginal e HRT (M = 2.5, SD = 1.5) compared to the 38 controls who were not using e HRT (M = 3.5, SD = 1.6) demonstrated significantly lesser frequency of UTI, t (78) = -2.56, p = .012. All the episodes of symptomatic UTI among cases were uncomplicated whereas 1 episode of UTI among 4 comparators forced for withdrawal of SGLT2 I and exclusion from observation period. The Fisher exact test statistic value is 0.0467. The result is significant at p < .05.

Conclusion: Estrogen HRT after menopause significantly reduces the frequency of UTI among T2DM females using SGLT2 I. Not using eHRT in these group of subjects may significantly increase risk of complicated UTI.


A. Gautam: None. P.K. Agrawal: None. N. Pursnani: None. R. Rani: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at