Dr Elrike van der Merwe

27/07/2026

12/07/2026

🚨 New Substack is out. I’m discussing a paper that didn’t make the news very much which is wild to me.
Nearly 2 million women with recurrent UTIs.

Women using vaginal estrogen didn’t just have fewer infections.

They had dramatically lower rates of death.

Not by a little.

The odds ratio for death ranged from 0.2 to 0.38.

If you read research, you know that’s a massive signal. We’re talking about a 60–80% reduction in the odds of dying over 8 years.

This isn’t some expensive new biologic.

This is generic vaginal estrogen. A medication we’ve had since the 1970s. Cheap. Local. Minimal side effects.

And here’s what’s wild (if that wasn’t enough).

The benefit wasn’t limited to women in menopause.

The pattern held all the way down to age 20.

This isn’t just a menopause story.

It’s a story about people with vaginal tissue who suffer from recurrent urinary tract infections.

Then I compared the numbers to average death rate.

The average 8-year risk of death for women in their 60s is around 7%.

Women in this study with recurrent UTIs—who should have been sicker than the average population—had an 8-year mortality of just 1.5% if they were using vaginal estrogen.

A group expected to do worse actually did better than the general population.

That should make all of us stop.

I’ve compared vaginal estrogen to seatbelts and airbags because the magnitude is in the same ballpark. We don’t argue whether seatbelts save lives. We just use them.

So why aren’t we treating vaginal estrogen with the same respect when the data look this compelling?

And maybe the most frustrating question…

Why is nobody talking about this?

A database of over 300 million patient records. Nearly 2 million women. A consistent, clinically meaningful finding.

Normally, studies like this generate headlines.

This one generated…

Crickets.

Why?

I dig into the study, the numbers, what they mean, and why I think this should change how we think about recurrent UTIs and vaginal estrogen.

And also why I think no one cares that much to have it make the news.

Read today’s Substack. Then tell me if you think this deserves more attention. Or why

04/07/2026

Breast cancer can happen to anyone – no matter your ethnicity, gender or age. So it’s really important to get to know your body and check yourself regularly.

It only takes a few minutes, and there’s no special technique. ​

It’s as simple as TLC: ​
Touch your breasts or chest ​
Look for changes ​
Check anything unusual with a GP

Learn the signs and symptoms of breast cancer 👇
https://brnw.ch/21x3N47

30/06/2026

01/05/2026

We so often overlook the “they were your babies” part when we focus on the medical side which always only involves the woman. Remember the dad.

04/02/2026

Great news for women’s health in South Africa! The Department of Health launched the 2026 HPV vaccination drive on February 2, targeting girls aged 9 and older to prevent cervical cancer, which claims over 3,000 lives yearly. With over 5,700 new cases annually and expanded access to public and private schools, this free, safe vaccine—proven effective since 2014—empowers the next generation. Parents, sign those consent forms and protect our daughters!

The Department of Health will this week (Monday, 02 February) kick-off the 2026 Human Papilloma Virus (HPV) Vaccination drive to protect girls aged 9 years and older from developing cervical cancer later in life. South Africa continues to record a high number of cases of cervical cancer and related....

25/01/2026

https://www.who.int/news/item/25-09-2025-contraceptive-use--a-catalyst-for-women-s-health-and-socioeconomic-empowerment

A new evidence brief from the United Nations’ Special Programme in Human Reproduction (HRP) and the World Health Organization (WHO) underscores the transformative impact of contraceptive use on women’s health and socioeconomic status.