Ask the doctors: Readers respond

Hello, dear readers! Welcome to a bonus letters column. Right before writing this column, we made the annual shift into daylight saving time. We’ve given up an hour of morning light for a longer, sunlit evening. DST sparks debate on a range of issues, including the potential effects on sleep and health. We’ll be exploring some of those soon. But now, on to your letters.

A column that looked at how urinary tract infections (UTIs) can occur continues to generate mail. We heard from several women who, like the writer of that original letter, practice scrupulous personal care and yet have recurrent UTIs. For those who are not familiar, most UTIs are caused by E. coli, a common gastrointestinal bacterium. Due to the proximity of the anus and urethra in women, these bacteria can transfer, even with vigilant hygiene. This can lead to the idea that recurrent UTIs mean someone isn’t washing properly.

• “I can relate to the writer’s frustration about attitudes friends and family hold about the cause of UTIs – I had two or three per year,” a reader wrote. “A new urologist prescribed vaginal estrogen twice weekly, a daily probiotic and a cranberry extract supplement, and it has now been a year since my last one. I hope you will pass on this.”

• A reader in Norfolk, Virginia, had a similar experience. “I have had a long history of UTIs despite staying scrupulously clean,” she wrote. “After my doctor prescribed a vaginal estrogen suppository along with cranberry pills, voila! No more UTIs!”

• This was echoed by a reader in Los Angeles. “For a long time, UTIs were just a fact of life. I didn’t need antibiotics each time, so my doctor didn’t know how much it was happening,” she wrote. “When I talked to him about it, he had me start using a vaginal estrogen cream and take a cranberry concentrate. What a difference – I have had only one UTI in the last two years.”

One of the common threads here is use of low-dose estrogen cream. This topical application helps to address the issue of thinning genital tissues, which is common in perimenopause and after menopause. Low-dose estrogen, which has been shown to be quite benign, strengthens the fragile tissues. This, in turn, helps support the microbial environment that can protect against harmful bacteria. Probiotics may also bolster a beneficial balance to the vaginal and intestinal microbiomes.

Newer research suggests concentrated cranberry products may also have a protective effect. This is due to the presence of certain compounds in the fruit. These compounds appear to disrupt the ability of E. coli to adhere to the inside of the urinary tract and bladder. For anyone struggling with UTIs, it’s a good idea to talk to your doctor and explore these approaches.

Thank you, as always, for taking the time to write. We will be back soon with our regular monthly letters column.

Send your questions to askthedoctors@mednet.ucla.edu.