Recurrent UTIs After Hysterectomy: When antibiotics don't work?

My main issues post-total hysterectomy (four months ago) have been genitourinary so I feel for you. I've had two yeast infections and vaginal dryness. I've luckily not had a UTI yet but my bladder is frequently sore from IC/BPS. Prior to surgery, my bladder hurt terribly from endometriosis and adenomyosis so I went for two bladder instillation at my then gyno's office. I can say they helped with pain but have no idea if they work for UTIs. I'm curious to know anything about the Uromune vaccine so thank you for sharing it.

I use Uquora and I think it really helps. It’s probiotics and a packet that you mix with water to flush out your bladder. I was previously diagnosed with recurring UTIs, I had a hysterectomy 18 months ago and haven’t had any problems since other than one yeast infection. I swear by Uquora! You can order it online from their website.

Uromune vaccine-Studies from Europe show ~50–70% fewer UTIs, and some women become UTI-free for months to years. Uromune is NOT FDA-approved and not available in the U.S. as of now. It is available in some countries Spain, UK, Mexico, parts of Europe/LatAm.
Evidence is promising but based mostly on non-US studies; larger FDA-style trials are still lacking.

Have you considered or tried Estradiol cream applied to the urethra and vulva? It's very important and often overlooked. After hysterectomy low estrogen increases UTI risk.
Local estradiol keeps the vaginal & urethral tissue thick, elastic, and acidic, which, restores protective lactobacillus, and makes it harder for UTI bacteria to grow or attach. Large studies show ~50% reduction in recurrent UTIs with vaginal estrogen. It’s low-dose, local, and works where the problem is.
I had four UTIs between January and March 2025. Although I was already using vaginal estradiol twice a week, I didn’t notice a real difference until I began applying it nightly to the urethral area and vulva for a couple of months. Since April 2025, I’ve been UTI-free.
I had four UTIs between January and March 2025. Although I was already using vaginal estradiol twice a week, I didn’t notice a real difference until I began applying it nightly to the urethral area and vulva for a couple of months. Since April 2025, I’ve been UTI-free. If your UTI's are triggered by sex you can use a low dose Nitrofurantoin after sex to prevent a UTI. It's also used nightly for frequent UTIs not tied to sex. You are right to be concerned about continuous use of anti-biotic. Non-antibiotic options (D-mannose, methenamine

@kisu Thank you for these suggestions. Since @chigal10 had uterine cancer she may not be able to use any estrogen products.

@chigal10 If I may ask, what kind of uterine cancer was diagnosed? There are different kinds of uterine (endometrial) cancers such as

Endometrioid carcinoma
Serous carcinoma
Clear cell carcinoma
Undifferentiated carcinoma/ Dedifferentiated carcinoma
Mixed carcinoma
Carcinosarcoma

Here is a website that describes these cancers.

American Cancer Society: What is endometrial cancer?
https://www.cancer.org/cancer/types/endometrial-cancer/about/what-is-endometrial-cancer.html
If you would like to provide us with more information perhaps we can be more helpful to you. For instance, did your oncologist say anything about whether or not you can use estrogen products as described by @kisu?

@naturegirl5 @kisu Thanks for the suggestions and support.

So I had fibroids which fused to my uterus and upon surgery I was diagnosed with endometrioid carcinoma which resulted in the need for a hysterectomy. Luckily they left my ovaries (fwiw.)

I didn’t have any uti issues for a while, up until about a year in. Then I had my first UTI ever. I didn’t know what it was at first because I never had one so I had nothing to compare it to for reference.

Then I went back to my oncologist, thinking it was something related to my surgery such as a cuff issue.

However, it wasn’t and they ran a urine culture to find Ecoli and I was put on Macrobid which cleared it.

I’ve been taking cranberry supplements and D-mannose and using a sterile lubricant during sex called slippery stuff, which is sterile water-based lubricant. In addition to doing pelvic floor physical therapy.

Things seemed to be going all right until about February of last year 2025, when I developed another UTI out of nowhere.

After that was cleared up, I tried estradiol cream. I felt like that was helping my symptoms a little in terms of dryness and pain, but then unfortunately for me 2 weeks or so into using that I developed a yeast infection and then subsequent UTI. I’m not sure if they’re related to the cream use or not.

Now that I moved to Minnesota I’m in the process of finding all new doctors. I did already meet with a menopause specialist, and I’m hoping that will be a good fit.

She recommended trying an extremely low dose of estrogen via vaginal tablet method, which I have not done before.

I’m willing to give this a try but I’m still extremely nervous that I’ll develop a yeast infection or uti.

I also have to be very careful with any hormone therapy— even a low dose because I suffer from epilepsy and my seizures are triggered by hormones. So a urogynecologist has to work in tandem with my neurologist to try to create a treatment plan that works well for me, which is not easy.

To add insult to injury, I’m also progesterone sensitive. So in theory progesterone HRT can actually help reduce some seizures; as it’s usually estrogen that triggers seizures. That’s really my main hurdle rn.

It’s incredibly emotionally and physically stressful. 😥

My Mom had recurrent UTI's until she started using d-mannose and an estriol vaginal cream. I have read that you can just put a dot of it on the exterior parts to keep them supple. When the girlie parts (urethral orifice) dry out from lack of estrogen it allows bacteria from your urine/feces can migrate up the urinary tract and cause an infection. When the skin is moisturized it keeps the urethal opening to the urinary tract tighter and more secure from bacterial invasion.
If you want to avoid any estrogen products look for hyaluronic acid vaginal suppositories. Each suppository is about 3/4 inch long and looks like it is made from compresssed coconut oil. I cut each suppository in half as a whole one is too much moisturizer for me and makes a greasy mess. You use it just before you get into bed so it stays in place as long as possible. The cheapest source of Hyaluronic Acid Suppositories that I can find is CVS pharmacy, they sell a generic version, around $20 for 10 suppositories. I also use an eye drop that has hyaluronic acid in it and it has been such a help with my dry eyes.

@chigal10 Thank you for explaining what prompted you to write your initial post. I can only imagine what a frustrating and painful these past 12 months have been for you. Yes, emotional stress and physical pain. I'm relieved to know that you've connected with a menopause specialist. I hope, too, that this will be a good fit for you.

Your post reminds me of the often inaccurate and unhelpful advice and recommendations I received from providers who were not specialists with menopause. After my hysterectomy at Mayo in Rochester I received a referral to their Menopause and Women's Sexual Health Clinic.

-- https://www.mayoclinic.org/departments-centers/menopause-womens-sexual-health/overview/ovc-20487915

This is where I met with very helpful providers including a nurse educator, who made recommendations not only on products, but how they worked and how to use them.

I hope that the most recent recommendation of the low dose vaginal tablet will work for you.