Preference of Women With Recurrent Urinary Tract Infection for Vaginal Estradiol Tablet vs Cream

Inclusion Criteria: Women age 20-80 who are post-menopausal or have undergone surgical menopause. Post-menopausal defined as amenorrhea for ≥ 1 year, or surgical menopause through bilateral oophorectomy, or menopausal symptoms for ≥ 1 year in women with prior hysterectomy New or previous diagnosis of recurrent Urinary Tract Infections (rUTI) (3 or more UTIs in the past year or 2 or more UTIs in the last 6 months) Must have at least one culture documented UTI, the remaining can be documented by urinalysis showing nitrites and leukocyte esterase. Not currently taking daily prophylactic antibiotics Willing to use vaginal estrogen for prevention of recurrent UTIs Exclusion Criteria: Interstitial cystitis or bladder pain syndrome, nephrolithiasis, genitourinary abnormalities, fistula, history of renal transplant or anatomic abnormality of the kidney Fecal incontinence, intermittent catheterization or indwelling catheter, poorly controlled DM, urothelial cancer, estrogen-sensitive cancer including active breast cancer Recent urologic surgery within 3 months Inability to retain vaginal tablet (ex due to advanced prolapse, history of colpocleisis) Other medical reasons that are deemed incompatible with vaginal estrogen treatment Use of vaginal estrogen in the past 1 month- patients can be recruited after a 1 month wash-out period Inability to follow up at clinic study site to give sample, for example due to transportation issues Organ transplant patients Patients on systemic hormone replacement therapy (HRT)