Inclusion Criteria:

• Female patient > 18 years old.
• Postmenopausal status, documented by prior bilateral salpingo-oophorectomy, or absence of menses >12 months.
• Recurrent urinary tract infections as defined by 3 culture positive urine cultures in the last 12 months, or 2 positive urine cultures in the last 6 months.
• Positive urine cultures defined by > 100K colony forming units of 1 or 2 bacterial species on clean catch sample, or > 1000 colony forming units of 1 or 2 bacterial species on sample via straight catheterization.
• Patients on vaginal estrogen must undergo a 1 month washout period prior to initiation of the trial.

Exclusion Criteria:

• Hematuria without appropriate workup.
• Pelvic organ prolapse at or beyond the hymen.
• Clinically relevant urinary retention.
• Pelvic reconstructive surgery within 6 months.
• Prior synthetic mesh procedure for pelvic organ. prolapse or urinary incontinence.
• Clinically relevant nephrolithiasis.
• History of breast cancer.
• Contraindication to topical estrogen therapy.
• Anticoagulation therapy.
• Prior pelvic or vaginal radiation therapy.
• Prior gynecologic malignancy.
• Undiagnosed genital bleeding.