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Recurrent urinary tract infection after menopause — DRCOG MCQ

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ModerateUrogynaecologyRecurrent urinary tract infection after menopauseDRCOG

A 63-year-old postmenopausal woman has recurrent dysuria and frequency, with three culture-proven lower UTIs in 8 months. She has vaginal dryness and dyspareunia. Renal function is normal. What is the most appropriate management?

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Correct answer: E — Consider vaginal oestrogen after discussing benefits and risks

Postmenopausal genitourinary syndrome can contribute to recurrent UTIs, and vaginal oestrogen can reduce recurrence after discussion. Long-term antibiotics may be considered later depending on assessment, but immediate lifelong antibiotics are not first-line. Cranberry evidence is variable and not a replacement for structured care. The pearl is that local oestrogen has minimal systemic absorption for most women.

Reference: NICE NG112; NICE NG123; NICE NG23