Recognizing and Treating Urogenital Atrophy in Postmenopausal Women

Abstract

Urogenital atrophy resulting from postmenopausal estrogen deficiency has numerous clinical effects, including vaginal dryness, sexual dysfunction, urinary incontinence, and recurrent urinary tract infections (UTIs), all of which can cause significant distress and reduction in quality of life. Although nearly one third to one half of postmenopausal women experience these symptoms, they are often overlooked because patients may be reluctant to discuss them and clinicians fail to screen for them. As these symptoms are unlikely to resolve without treatment, the prompt diagnosis and treatment of urogenital atrophy is essential. Estrogen therapy, administered either locally or systemically, provides significant relief from symptoms related to urogenital atrophy. However, systemic estrogen therapy is contraindicated in some women and may not be accepted in women without other menopausal symptoms. Local low-dose vaginal estrogen therapy, in the form of vaginal estrogen tablets, creams, or rings, has been shown to reduce dyspareunia and vaginal dryness, restore vaginal pH, and restore normal vaginal cytology. All forms of vaginal estrogen therapy are effective and well tolerated, although vaginal tablets and rings may have fewer adverse effects and have higher rates of adherence than creams.

Management of Postmenopausal Vaginal Atrophy: Review of Literature

“…30 Thus, 10 to 25% of women using systemic hormonal therapy will still experience the symptoms of urogenital atrophy. This finding plus the safety concerns about oral/transdermal HRT are the reasons why systemic therapy is usually not recommended in women with vaginal symptoms only, 31 and in many women, a combination of systemic and vaginal estrogen may be necessary initially.…”

Drug therapies for postmenopausal urinary incontinence

“…Urogenital tissue is dependent upon oestrogen stimulation to mainatin normal strcuture and function. Oestrogen receptors can be found in the vagina, vulva, urethra and bladder neck (Blakeman et al, 2001 andGoldstein, 2010). The physiological effects of the menopause result in a decline in circulating oestrogen, potentially leading to urogynaecological dysfunction including urgency, frequency, dysuria, incontinence and recurrent urinary tract infections (American College of Obstetricians and Gynaecologists Women's Healthcare Physicians, 2004 andMacLennan, 2000).…”

Promoting urinary continence in older women

“…Urogenital tissue is dependent on oestrogen stimulation to maintain normal structure and function. oestrogen receptors are found in the vagina, vulva, urethra and bladder neck (Goldstein, 2010 andBlakeman, Hilton andBulmer, 2001). The physiological effect of the menopause leads to decling levels of circulating oestrogen putting postmenopausal women at risk of urogynaecological dysfunction, urgency, frequency, dysuria, incontinence and recurrent urinary tract infections (MacLennan, 2000 and (American College of Obstetricians and Gynaecologists Women's Healthcare Physicians., 2004).…”

“…Atrophy or inflammation of the vagina due to a lack of oestrogen can lead to decreased strength in the pelvic floor muscles. The atrophic vaginal mucosa also causes vaginal discomfort, buring, itching and associated dyspareunia (Goldstein, 2010). Arthritis is stronlgy associated with incontinence.…”