Urogenital complaints such as vaginal discomfort, dysuria, dyspareunia, recurrent lower urinary tract infections and urinary incontinence are more common in women after the menopause. Epidemiological studies have demonstrated that more than 50% of postmenopausal women suffer from at least one of these symptoms. They cause not only discomfort, but may also negatively influence sexual health. Many women are so embarrassed that they are unable to discuss their dilemma with other women or their doctor. Embryologically the female genital tract and urinary systems develop in close proximity, both arising from the primitive urogenital sinus. Animal and human studies have shown that the urethra is oestrogen sensitive, and oestrogen receptors have been identified in the urethra, urinary bladder, the vagina and the pelvic floor muscles. There is now a wealth of evidence to support the efficacy of exogenous oestrogens in the treatment of urogenital symptoms caused by postmenopausal ovarian insufficiency.
. BarlowDHCardozoLDFrancisRMGriffinMHartDMStephensESturdeeDW. Urogenital ageing and its effect on sexual health in older British women. Br J Obstet Gynaecol1997; 104: 87–91.
2.
. GrimbyAMilsomIMolanderUWiklundIEkelundP.The influence of urinary incontinence on the quality of life in elderly women. Age Ageing1993; 22: 82–89.
3.
. IosifCSHenrikssonLUlmstenU.The frequency of disorders of the lower urinary tract, urinary incontinence in particular as evaluated by a questionnaire survey in a gynecological health control population. Acta Obstet Gynecol Scand1981; 60: 71–76.
4.
. BergGGottqallTHammarMLindgrenR.Climacteric symptoms among women aged 60–62 in Linköping, Sweden, in 1986. Maturitas1988; 10: 193–199.
5.
. MolanderUMilsomIEkelundPMellströmD.An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women. Maturitas1990; 12: 51–60.
6.
. BarlowDHSamsioeGvan GeelenJM. A study of European women's experience of urogenital ageing and its management. Maturitas1997; 27: 239–247.
7.
. BartlettJGOnderdonkABDrudeEGoldsteinCAnderkaMAlpertSMcCormackWM. Quantitative bacteriology of the vaginal flora. J Infect Dis1977; 136. 271–277.
8.
. OsborneNGWrightRCGrubinL.Genital bacteriology: A comparative study of premenopausal women with post-menopausal women. Am J Obstet Gynecol1979; 135. 195–198.
9.
. MilsomINilssonLÅBrandbergÅEkelundPMellströmDErikssonD.Vaginal immunpglobulin A (IgA) levels in postmenopausal women: influence of oestriol therapy. Maturitas1991; 13: 129–135.
10.
. MilsomIArvidssonLEkelundPMolanderUErikssonO.Factors influencing vaginal cytology, pH and bacterial flora in elderly women. Acta Obstet Gynecol Scand1993; 72: 286–291.
11.
. BaronJALa VecchiaCLeviF.The antiestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol1990; 162: 502–14.
12.
. BaronJAAdamsPWardM.Cigarette smoking and other correlates of cytologic estrogen effect in postmenopausal women. Fertil Steril1988; 50: 766–71.
13.
. HellbergDNilssonSHaleyNJHoffmanDWynderEL. Smoking and cervical intraepithelial neoplasia: Nicotine and cotinine in serum and cervical mucus in smokers and non-smokers. Am J Obstet Gynecol1988; 158: 910–3.
14.
. TaylorP.Ganglionic stimulating and blocking agents. In: Goodman Gilman A, Goodman LS and Gilman A, editors: The Pharmacological basis of Therapeutics, 6th ed.New York: Macmillan Publishing Co. Inc., 1980: 213–4.
15.
. NordqvistPEkelundPEdouardLSvenssonM-LBrandbergÅSeebergS.Catheter-free geriatric care. Routines and consequences for clinical infection, care and economy. J Hosp Inf1984; 5: 298–304.
16.
. BrandbergÅMellströmDPerssonUÖdegaardK.Urogenital oestrogen deficiency syndrome among women aged 65+: An assessment of the economics of its treatment. IHE Working paper 1991: 1. The Swedish Institute for Health Economics, 1991.
17.
. ThomasTMPlymatKRBlanninJMeadeTW. Prevalence of urinary incontinence. Br Med J1980; 281: 1243–1245.
18.
. HellströmLEkelundPMilsomIMellströmD.The prevalence of urinary incontinence and incontinence aids amongst 85-year old men and women. Age Ageing1990; 19: 383–9.
19.
. MilsomIEkelundPMolanderUArvidssonLAreskougB.The influence of age, parity, oral contraception, hysterectomy and the menopause on the prevalence of urinary incontinence in women. J Urol1993; 149: 1459–1462.
20.
. SamuelssonEVictorATibblinG.A population study of urinary incontinence and nocturia among women 20–59 years. Prevalence, well-being and wish for treatment. Acta Obstet Gynecol Scand1997; 76: 74–80.
21.
. JolleysJ.Reported prevalence of urinary incontinence in women in a general practice. Br Med J1988; 296: 1300–1302.
22.
. ElvingLBFoldspangALamGWMommsenS.Descriptive epidemiology of urinary incontinence in 3,100 women age 30–59. Scand J Urol Nephrol1989Suppl 125: 37–43.
23.
. MäkinenJIGrönroosMKiilholmaPJATenhoTTPirhonenJPErkkolaRU. The prevalence of urinary incontinence in a randomized population of 5247 adult Finnish women. Int Urogynecol J1992; 3: 110–113.
24.
. BrocklehurstJC. Urinary incontinence in the community - analysis of a MORI poll. Br Med J1993; 306: 832–834.
25.
. FalconerCBlomgrenBJohanssonOUlmstenUMalmströmAWestergren-ThorssonGEkman-OrdebergG.Different organization of collgen fibrils in stress-incontinent women of fertile age. Acta Obstet Gynecol Scand1998; 77: 87–94.
26.
. FalconerCEkman-OrdebergGBlomgrenBJohanssonOUlmstenUWestergren-ThorssonGMalmströmA.Parurethral connective tissue in stress-incontinent women after menopause. Acta Obstet Gynecol Scand1998; 77: 95–100.
27.
. HuT-W.Impact of urinary incontinence on health-care costs. J Am Geriatr Soc1990; 38: 292–295.
28.
. EkelundPGrimbyAMilsomI.Urinary incontinence: Social and financial costs high. Br Med J1993; 306: 1344.
29.
. KicovicPMCortes-PrietoJMilojevicSHaspelsAAAljinovicA.The treatment of postmenopausal vaginal atrophy with Ovestin vaginal cream or suppositories: Clinical, endocrinological and safety aspects. Maturitas1980; 2: 275–282.
30.
. MattssonL-ÅCullbergG.A clinical evaluation of treatment with estriol vaginal cream versus suppository in post-menopausal women. Acta Obstet Gynecol Scand1983; 62: 397–401.
31.
. BrandbergÅMellströmDSamsioeG.Low dose oral estriol treatment in elderly women with urogenital infections. Acta Obstet Gynecol Scand1987 (Suppl 140): 33–38.
32.
. MolanderUMilsomIEkelundPMellströmDErikssonO.Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post-menopause. Maturitas1990; 12: 113–120.
33.
. NilssonKHeimerG.Low-dose oestradiol in the treatment of urogenital oestrogen deficiency - a pharacokinetic and pharmacodynamic study. Maturitas1992; 15: 121–127.
34.
. SmithPHeimerGLindskogMUlmstenU.Estradiol- releasing vaginal ring for treatment of postmenopausal urogenital atrophy. Maturitas1993; 16: 145–154.
35.
. HenrikssonLSternquistMBoquistLÅlanderUSeleniusI.A comparative multicenter study of the effects of continuous low-dose estradiol released from a new vaginal ring versus estriol vaginal pessaries in postmenopausal women with symptoms and signs of urogenital atrophy. Am J Obstet Gynecol1994; 171: 624–632.
36.
. StameyTA. The role of introital enterobacteria in recurrent urinary infections. J Urol1973; 109. 467–472.
37.
. RazRStammWE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med1993; 329: 753–756.
38.
. SalmonULWalterRIGastSH. The use of estrogens in the treatment of dysuria and incontinence in postmenopausal women. Am J Obstet Gynecol1941; 42: 845–847.
39.
. JudgeTDG. The use of quinestradiol in elderly incontinent women: a preliminary report. Gerontol Clin1969; 11: 159–164.
40.
. SamsioeGJanssonIMellströmDSvanborgA.The occurence, nature and treatment of urinary incontinence in a 70 year old population. Maturitas1985; 7: 335–342.
41.
. WalterSWolfHBarleboHJensenHK. Urinary incontinence in postmenopausal women treated with estrogens. A double-blind clinical trial. Urol Int1978; 33: 135–143.
42.
. MolanderUMilsomIEkelundPArvidssonLErikssonO.A health care programme for the investigation and treatment of elderly women with urinary incontinence and related urogenital symptoms. Acta Obstet Gynecol Scand1991; 70: 137–142.
43.
. CardozoL.Role of estrogens in the treatment of female urinary incontinence. J Am Geriatr Soc1990; 38: 326–328.
44.
. FantlJACardozoLMcClishDK. Estrogen therapy in the management of urinary incontinence in postmenopausal women: A meta-analysis. First report of the hormones and urogenital therapy committee. Obstet Gynecol1994: 83: 12–18.
45.
. AhlströmKSandahlBSjöbergBUlmstenUStormbyNLindskogM.Effect of combined treatment with phenyl-propanolamine and estriol, compared with estriol treatment alone, in postmenopausal women with stress urinary incontinence.
