In the context of postmenopausal gynecologic care, it is pertinent to address the correlation between decreased estrogen levels and the increased incidence of recurrent urinary tract infections (UTIs). The alterations in the vaginal microbiome associated with estrogen deficiency may compromise the protective barrier against uropathogens. What clinical experiences or recent evidence-based findings support the utilization of topical versus systemic estrogen therapy in the prophylaxis of recurrent UTIs? Additionally, how might emerging strategies that aim to restore or optimize the vaginal flora impact the management protocols for UTIs in this patient population?