A Retrospective Analysis of Hormonal Contraceptive Type and Recurrent UTI Risk in Reproductive-Aged Women
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Background: Urinary tract infections are highly prevalent among reproductive-aged women and recurrent episodes contribute substantially to repeated healthcare utilization, antibiotic exposure, and reduced quality of life. The role of hormonal contraceptive type in shaping recurrent UTI burden remains insufficiently defined despite the widespread and prolonged use of these methods. Objective: To investigate the association between specific hormonal contraceptive methods and recurrent urinary tract infection frequency among reproductive-aged women. Methods: A retrospective observational analysis was conducted using medical records of 332 women aged 18-45 years from tertiary care hospitals and affiliated outpatient clinics in Lahore, Pakistan. Eligible participants had used one hormonal contraceptive method for at least six months. Contraceptive categories included combined oral pills, progestin-only pills, injectable contraceptives, subdermal implants, and hormonal intrauterine devices. Recurrent UTI was defined using standard clinical criteria. Group comparisons were performed using one-way ANOVA, and multivariable linear regression was used to adjust for age, parity, and duration of contraceptive use. Results: Recurrent UTI was identified in 37.3% of participants. Mean UTI episode frequency differed significantly across contraceptive groups (F = 9.42, p < 0.001), with the highest burden among injectable contraceptive users (3.8 ± 1.2 episodes; 48.6% recurrent UTI) and the lowest among hormonal IUD users (2.3 ± 0.8 episodes; 25.0% recurrent UTI). Duration of use was positively correlated with UTI frequency (r = 0.41, p < 0.001). Injectable contraceptive use remained independently associated with higher UTI frequency after adjustment (β = 0.62, p = 0.002), whereas implant and hormonal IUD use were associated with lower frequency. Conclusion: Recurrent UTI burden differed across hormonal contraceptive methods, with higher burden observed among systemic progestin-dominant methods and lower burden among localized or lower-systemic-exposure methods. These findings support more individualized contraceptive counseling for women at risk of recurrent UTIs.
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