Researchers from Washington University School of Medicine, St. Louis, show that reservoirs of uropathogenic E. coli within the bladder exist in higher numbers post-menopause than pre-menopause in a mouse model, a finding that could help explain the greater prevalence of urinary tract infections in post-menopausal women. They also found that estrogen supplementation reduced the numbers of such reservoirs dramatically. The research was published online ahead of print in the journal Infection and Immunity.

Urinary tract infections (UTIs) afflict an estimated 13 million American women annually. Post-menopausal women are especially vulnerable to UTIs. The high incidence of UTIs in post-menopausal women has long been thought related to the menopausal fall in estrogen levels.

However, "estrogen therapy to help limit or prevent recurrent or chronic UTIs has not been consistently shown to be effective in reducing the burden of infections in this population," says Indira Mysorekar, a researcher on the study. "Given the increasing incidence of multidrug resistant bugs and the high incidence of UTIs in older women, it is vital that we fully understand the dynamics of estrogen interaction with uropathogenic Escherichia coli, and the course of UTIs, and model these to determine how they might intersect."

Uropathogenic E. coli also damage the bladder, says Mysorekar. "To repair the damage, new cells are produced that turn into specialized cells which make up the new bladder barrier," she says. "In the absence of estrogen," as in post-menopausal women, "this repair process was severely disrupted." Among other things, abnormally elevated levels of immune system cytokines may damage bladder cells. In the mouse menopause model, "the cytokine levels are very high," she says. However, the researchers found that estrogen supplementation can reduce the levels of cytokines, as well as the infectious reservoirs to levels found pre-menop
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