***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The effect of oral oestriol ( 3 mg/day for 4 weeks followed by 2 mg/day for a further 6 weeks ) on the vaginal bacterial flora , vaginal cytology and urogenital symptoms was assessed in a double-blind , placebo-controlled study in 35 women with symptoms of the urogenital oestrogen deficiency syndrome . No significant differences were observed with regard to the occurrence or severity of urogenital symptoms , vaginal pH , karyopyknotic index ( KPI ) or the baseline results of vaginal bacterial cultures in the 18 patients ( mean age 71.6 + /- 1.0 years ) treated with oestriol and the 17 women ( mean age 72.6 + /- 1.4 years ) who received placebo tablets . A decrease in both vaginal pH ( P less than 0.001 ) and the proportion of faecal-type bacteria ( P less than 0.05 ) , and an increase in the KPI ( P less than 0.01 ) and the proportion of lactobacilli ( P less than 0.001 ) were recorded after 10 weeks of treatment with oral oestriol . At the end of the following 10 medication-free weeks all of these parameters except vaginal pH had returned to values that were not significantly altered from the corresponding baseline levels . In the patients treated with placebo no significant changes occurred in vaginal pH , KPI or the proportion of lactobacilli in vaginal cultures during the course of this study . Urogenital symptoms improved in both groups after medication ( and even after the medication-free period ) in relation to the baseline assessment , which reflects the latter 's subjective nature OBJECTIVE We studied the efficacy , safety , and acceptability of an estradiol-releasing ( 6.5 to 9.5 micrograms per 24 hours ) silicone vaginal ring ( Estring ) in postmenopausal women with symptoms and signs of urogenital aging during a treatment period of 1 year . STUDY DESIGN The study was open with blind analysis of vaginal cytologic testing . In addition to gynecologic examination , subjective symptoms were assessed and vaginal pH and urinary sample s ( for bacteriuria ) were obtained before insertion of Estring . This procedure was repeated every 3 months up to 1 year 's treatment , together with requests concerning acceptability and adverse experiences . At inclusion and end of Estring treatment , vaginal smears for evaluation of cytologic results were obtained . RESULTS Estring induced a high maturation value in the vaginal mucosa and restored vaginal pH to levels normality seen in fertile women ( < 5.5 ) . For most variables a 90 % responder rate ( proportion of cured and improved patients ) was found after 3 months and up to 1 year regarding subjective symptoms and objective signs of vaginal mucosal atrophy .  Twenty-eight ( 20 % ) of 136 women , withdrew from the study , 8 ( 6 % ) of them because of adverse events .  Three women reported vaginal bleeding , none associated with malignancy or endometrial proliferation . Ten ( 7 % ) reported vaginal irritation , and in two cases vaginal ulcers were found . About 90 % did not remove the ring during any of the 3-month treatment periods , and 78 % used the four consecutive rings continuously up to 1 year . The ring was given a strong preference ( p < 0.001 ) by patients with previous experience of other administration forms . CONCLUSION Estring represents a safe , highly effective , and very well-accepted administration form for long-term treatment of urogenital disorders caused by estrogen deficiency in postmenopausal women We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal ( NM ) therapy for preventing urinary tract infection ( UTI ) in postmenopausal women with recurrent UTI . Over a period of 9 months , 86 women received an  estriol-containing vaginal pessary ( 0.5 mg estriol ) twice weekly , and 85 women received NM ( 100 mg ) once daily . We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM ( P=.0003 ) . Twenty-eight women ( 32.6 % ) who received estriol had no episodes of UTI versus 41 women ( 48.2 % ) in the NM group . There was a significant increase in the number of superficial cells in women who received estriol , whereas in the NM group , no such changes occurred . However , there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol . Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women OBJECTIVE The primary objective was to detect a difference in time until the first recurrence of urinary tract infection during treatment with an estradiol-releasing silicone vaginal ring ( Estring ; Pharmacia & Upjohn , Inc , Uppsala , Sweden ) compared with no estrogen treatment . The secondary objective was to detect any differences in improvement of urethral and vaginal mucosal atrophy and in the subjective assessment of urogenital symptoms . The study also sought to detect a difference in decrease of vaginal pH to < 5.5 and to record adverse events . STUDY DESIGN This was a multicenter , r and omized , open , parallel-group study with an untreated control group . Postmenopausal women with recurrent symptomatic , bacteriologically confirmed urinary tract infections were r and omly assigned to receive either Estring ( 2 mg estradiol ) or no estrogen treatment . One ring was carried vaginally for 12 weeks . The duration of treatment was 36 weeks for the Estring group and either 36 weeks or until the first recurrence for the control group . Both intent-to-treat and per- protocol analyses were performed to evaluate efficacy , whereas the safety analysis was limited to the intent-to-treat group . The primary variable was analyzed by survival analysis with the Kaplan-Meier method for estimating the survival density function . To compare the survival curves for the 2 treatment groups a log-rank test was performed for time until first recurrence . RESULTS A total of 108 women were r and omly assigned , 53 to the Estring group and 55 to the control group . The cumulative proportion of women remaining free of urinary tract infection was significantly higher in the Estring group than in the control group ( P = .008 ) . After 36 weeks of study the cumulative likelihood of remaining free of disease was approximately 45 % in the women with the vaginal ring compared with approximately 20 % in the control group . Estring lowered vaginal pH , and the time to first recurrence was effectively prolonged by Estring treatment . Vaginal and , to a lesser extent , urethral mucosal cells were significantly more mature in the Estring group . No unexpected adverse events were found . CONCLUSION Estring is useful to prolong the time to next recurrence among postmenopausal women with recurrent urinary tract infection and to decrease the number of recurrences per year . The silicone vaginal ring also has a clinical ly significant ability to alleviate other postmenopausal urogenital symptoms . Estring is safe and well tolerated To evaluate factors associated with recurrent urinary tract infection ( UTI ) in postmenopausal women , we conducted a case-control study comparing 149 postmenopausal women referred to an infectious diseases outpatient clinic who had a history of recurrent UTI ( case patients ) with 53 age-matched women without a history of UTI ( control patients ) . Each woman completed a question naire providing demographic data , history and clinical characteristics of prior infections , and information regarding risk factors for UTI . In addition , each patient underwent a gynecologic evaluation , renal ultrasound and urine flow studies , and blood group and secretor status testing . Three urologic factors-namely , incontinence ( 41 % of case patients vs. 9.0 % of control patients ; P<.001 ) , presence of a cystocele ( 19 % vs. 0 % ; P<.001 ) , and postvoiding residual urine ( 28 % vs. 2.0 % ; P=.00008)-were all strongly associated with recurrent UTI . Multivariate analysis showed that urinary incontinence ( odds ratio [ OR ] , 5.79 ; 95 % confidence interval [ CI ] , 2.05 - 16.42 ; P=.0009 ) , a history of UTI before menopause ( OR , 4.85 ; 95 % CI , 1.7 - 13.84 ; P=. 003 ) , and nonsecretor status ( OR , 2.9 ; 95 % CI , 1.28 - 6.25 ; P=.005 ) were most strongly associated with recurrent UTI  in postmenopausal women . Prospect i ve studies are needed to confirm these observations and to develop approaches for prevention To determine whether the combined contraceptive pill used intravaginally was as effective as the st and ard conjugated estrogen cream for the treatment of urogenital symptoms in postmenopausal Thai women OBJECTIVE Estrogen or combined hormone ( estrogen-progestin ) therapy is highly efficacious for managing the signs and symptoms of urogenital atrophy . A low , effective estrogen dose may enhance patient acceptance and reduce side effects . METHODS In this r and omized , double-blind , multicenter clinical trial , 71 healthy postmenopausal women with vaginal atrophy ( Vaginal Maturation Index < or = 55 ) received either low-dose synthetic conjugated estrogens , A tablets ( Cenestin ) ( SCE-A ) , 0.3 mg once daily , or placebo for 16 weeks . RESULTS Treatment with SCE-A for 16 weeks result ed in a highly significant ( P<0.0001 ) mean increase of 17.7 in the Vaginal Maturation Index compared to a mean increase of 4.1 with placebo treatment . A significant estrogenic improvement was detected as early as 4 weeks ( mean increase 14.6 ) . Superficial cells were significantly increased from 2.1 % at baseline to 15.9 % at week 16 with SCE-A , and parabasal cells were significantly reduced from 23.0 % at baseline to 1.6 % at week 16 ( P<0.01 between treatments for both ) . Vaginal pH was significantly decreased from 6.2 at week -2 to 5.2 at week 16 with SCE-A compared to placebo ( P<0.0001 ) . There were no significant differences between treatment groups in the incidence of treatment-emergent side effects or other measures of safety , except for urinary tract infection , which occurred more frequently in the placebo group . CONCLUSIONS These results confirm the relatively rapid estrogenic effect and safety of a low-dose ( 0.3 mg/day ) of slow-release SCE-A ( Cenestin ) in the treatment of vaginal atrophy in postmenopausal women A block r and omized , double-blind , group-comparative , placebo-controlled study was conducted to assess the effect of oestriol on recurrent urinary tract infections in postmenopausal women . 40 women , median age 78 years ( 66 - 91 ) , 20 in each group , were treated with oestriol three mg p.o . per day or corresponding placebo for four weeks , followed by one mg per day for eight weeks . The main response parameter was the number of urinary tract infections per week in the two treatment periods . Both oestriol and placebo reduced the number of infections per week significantly in both periods , compared with the pretreatment period . There was no difference between oestriol and placebo treatment in the first period . In the second period , however , oestriol treatment was significantly more effective than placebo ( p = 0.05 ) . Correspondingly , there was a significant difference between the two groups in the vaginal pH at the end of the study ( p less than 0.05 ) . We conclude that oestriol reduces recurrent urinary tract infections in postmenopausal women BACKGROUND Recurrent urinary tract infections are a problem for many postmenopausal women .  Estrogen replacement restores atrophic mucosa , lowers vaginal pH , and may prevent urinary tract infections . METHODS We enrolled 93 postmenopausal women with a history of recurrent urinary tract infections in a r and omized , double-blind , placebo-controlled trial of a topically applied intravaginal estriol cream . Midstream urine cultures were obtained at enrollment , monthly for eight months , and whenever urinary symptoms occurred . Vaginal cultures and pH measurements were obtained at entry and after one and eight months . The women were assigned to receive either estriol ( n = 50 ) or placebo ( n = 43 ) , both administered intravaginally ; 36 and 24 , respectively , completed the eight months of follow-up . RESULTS The incidence of urinary tract infection in the group given estriol was significantly reduced as compared with that in the group given placebo ( 0.5 vs. 5.9 episodes per patient-year , P < 0.001 ) . Survival analysis showed that more of the women in the estriol group than in the placebo group remained free of urinary tract infection ( P < 0.001 ) . Lactobacilli were absent in all vaginal cultures 
    Output:
    
AUTHORS ' CONCLUSIONS Based on only two studies comparing vaginal oestrogens to placebo , vaginal oestrogens reduced the number of UTIs in postmenopausal women with RUTI , however this varied according to the type of oestrogen used and the treatment duration