Read Full Story"This cream can also help prevent death from urinary tract infections," Rubin said, referring to low-dose vaginal estrogen therapy.
Unlike hormone replacement therapy taken orally, vaginal estrogen is applied locally as a cream, tablet or ring.
In postmenopausal women who experience recurrent UTIs, local vaginal estrogen helps restore the health of the vaginal and urinary tissues affected by declining estrogen levels.
"Current clinical guidelines recommend local vaginal estrogen as an effective preventive option for appropriately selected postmenopausal women with recurrent UTIs.
Vaginal estrogen creams offer valuable non-antibiotic preventive approach, helping reduce repeated antibiotic use while supporting overall urinary and vaginal health.
A low-dose vaginal estrogen cream, costing little more than a meal in many countries, is gaining attention after urologist Dr. Rachel Rubin said it could dramatically reduce urinary tract infections (UTIs) in older women and potentially prevent life-threatening complications.
Speaking on the podcast, The Diary of a CEO, hosted by entrepreneur Steven Bartlett, Rubin expressed frustration that vaginal estrogen remains underused despite decades of evidence supporting its benefits.
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"This cream can also help prevent death from urinary tract infections," Rubin said, referring to low-dose vaginal estrogen therapy.
WHY ARE OLDER WOMEN MORE VULNERABLE TO UTIs?
UTIs are among the most common bacterial infections in women. While many infections are easily treated, recurrent UTIs can become a serious problem after menopause.
Falling estrogen levels cause changes in the vaginal and urinary tract tissues. The tissues become thinner and drier, while beneficial bacteria that normally protect against infection decline.
These changes make it easier for harmful bacteria to enter and multiply in the urinary tract.
Dr. Rachel Rubin says a $14 cream can prevent women from dying of UTIs.
A urologist, she's furious this isn't common knowledge.
Vaginal estrogen, rubbed in twice a week like sunscreen, does a lot at once:
Fewer UTIs
Less urgency and leakage
Less painful, dry sex
"this cream pic.twitter.com/IJS4LtWXd2— Goku (@ProjectGokuu) June 24, 2026
In some older adults, a UTI can progress beyond the bladder and kidneys, triggering sepsis, a life-threatening reaction to infection.
WHAT DOES VAGINAL ESTROGEN DO?
Unlike hormone replacement therapy taken orally, vaginal estrogen is applied locally as a cream, tablet or ring. The treatment helps restore the health of vaginal and urethral tissues and promotes the growth of protective bacteria.
Research suggests this local treatment can significantly reduce recurrent UTIs in postmenopausal women.
A randomised clinical trial found that women using vaginal estrogen experienced fewer recurrent UTIs than those receiving placebo treatment.
According to Dr. Ajay Aggarwal, Consultant, Urology, RG Hospitals, Delhi, vaginal estrogen creams are widely available in India as prescription drugs. However, in India, the bigger challenge isn't availability but awareness among postmenopausal women who don't know that various symptoms point to low estrogen levels.
"Many postmenopausal women experiencing recurrent UTIs, vaginal dryness, burning, or urinary discomfort do not realise that these symptoms may be linked to declining estrogen levels after menopause. As a result, many continue taking repeated courses of treatment for infections or discomfort without addressing the underlying cause. Greater awareness among women as well as healthcare providers can help ensure that suitable patients receive timely and appropriate treatment," said Dr. Ajay Aggarwal.
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Vaginal estrogen creams are preventative and not used as treatment, Dr. Aggarwal pointed out.
A 2026 systematic review and meta-analysis of randomised controlled trials also reported a protective effect, finding that vaginal estrogen substantially lowered the risk of recurrent UTIs in postmenopausal women.
Earlier reviews, including a Cochrane analysis, similarly concluded that vaginal estrogen reduces recurrent UTIs in postmenopausal women, although benefits varied depending on the formulation used and treatment duration.
BEYOND INFECTION PREVENTION
Doctors say the therapy could help with a broader condition known as genitourinary syndrome of menopause (GSM), which includes symptoms such as vaginal dryness, painful intercourse, urinary urgency and frequent urination.
According to Dr. Rubin and other menopause specialists, many women are unaware that these symptoms are linked to hormonal changes rather than simply ageing.
In postmenopausal women who experience recurrent UTIs, local vaginal estrogen helps restore the health of the vaginal and urinary tissues affected by declining estrogen levels.
This supports the natural protective environment and lowers the risk of future infections.
"Current clinical guidelines recommend local vaginal estrogen as an effective preventive option for appropriately selected postmenopausal women with recurrent UTIs. Antibiotics treat the infection, while vaginal estrogen helps reduce the likelihood of recurrence," Dr. Aggarwal added.
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IS IT SAFE?
Studies suggest that low-dose vaginal estrogen has minimal systemic absorption because it acts primarily on local tissues.
As a result, it is generally considered safer than systemic hormone therapy for many women, though treatment decisions should always be made in consultation with a healthcare provider.
For decades, recurrent UTIs in older women have been managed with repeated courses of antibiotics. Vaginal estrogen creams offer valuable non-antibiotic preventive approach, helping reduce repeated antibiotic use while supporting overall urinary and vaginal health.
Dr. Rubin's comments have reignited discussion about a therapy that has existed for years but remains unfamiliar to many patients.
The larger question, she suggests, is why a treatment supported by decades of evidence is still not routinely discussed with women entering menopause.
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