American University of Barbados School of Medicine, Wildey, Bridgetwon, Saint Michael, BB-11100, Barbados,

Department of Gynaecology, Nova IVF Infertility, Hazratganj, Lucknow, U.P. India-226003.

Department of Pathology,  Era's Lucknow Medical College & Hospital, Era University, Lucknow, Uttar Pradesh, India- 226003.

UTIs are one of the most common bacteriological infections among women that recur repeatedly and significantly deteriorate quality of life. UTIs in contact with hormonal milieu, especially concerning the menstrual cycle is a field of growing scientific interest. Despite the lack of real evidence to support the existence of a direct, causal relationship between an active UTI and menstrual irregularity, indirect relationships have become increasingly identified as mediated by changing sex-steroid hormones, modifications in the urogenital microbiome, the presence of systemic inflammation, and the use of hygiene practices. This systematic review will identify the current world and Indian studies to elucidate the complicated reciprocal association among UTIs and hormonal factors and investigate the identified association with the presence of a menstrual cycle abnormalities, a comprehensive literature search was conducted to identify the studies that determine the role of estrogen and progesterone in uroepithelial integrity, the relationships between the menstrual cycle phases and the UTI vulnerability, and effects of UTIs on the hypothalamic pituitary ovarian (HPO) axis, including menstrual cycle changes induced by stress and inflammation processes. This review highlights that low estrogen levels during the premenstrual period increase the risk of UTI due to microbiome disruptions in the vagina and urine. On the contrary, extreme infection or the related systemic stress may temporarily impair HPO axis, which may also lead to menstrual delay or irregularity. Moreover, the Indian studies reveal that poor management of menstrual hygiene is a crucial and alterable risk factor that relates menstruation to reproductive and urinary tract infections. These complex physiological and behavioural interrelationships need a better comprehension to enable the formulation of specific preventive and curative measures in female health.