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Objective To evaluate the effect and feasibility of using estrogen cream for the prevention and treatment of recurrent urinary tract infection (UTI) in postmenopausal women.Methods Forty-five postmenopausal women with a history of recurrent UTI were divided into two groups (group premarin and group antibiotic). Participants were assigned to apply intravaginal premarin cream (group premarin, n=30) or oral antibiotic (group antibiotic, n=15) for 3 months respectively. Urine routine test, midstream urine and vaginal cultures, vaginal health score (VHS), vaginal cell maturation value (MV), endometrial thickness and blood estrogen level were obtained before and after the study.Results The incidence of UTI in the group premarin was significantly reduced as compared with that in the group antibiotic (2/27 vs 12/15, P<0.001). In the group premarin Lactobacilli reappeared (from 0 to 59.3%) and MV (from 9.2±6.8 to 74.6±14.1) and VHS (from 5.2±0.4 to 13.4±2.5) were improved after 3 months. There was no significant change in the group antibiotic.Conclusion It seems that intravaginal use of estrogen cream would effectively prevent and reduce the UTI in postmenopausal women.