The pathophysiology and management of postmenopausal urogenital oestrogen deficiency

Abstract

Increasing life expectancy has led to an increasingly elderly population and it is now common for women to spend a third of their lives in the oestrogen-deficient postmenopausal state. Oestrogen is known to have an important physiological impact on the female lower urinary tract and the loss of endogenous oestrogen is associated with the development of urogenital atrophy and lower urinary tract dysfunction, offering a rationale for prevention and treatment. Whilst the role of systemic hormone replacement therapy and the use of topical oestrogens in the management of urogenital atrophy has been firmly established, the use of oestrogens in urinary incontinence remains more controversial. Oestrogen therapy alone has been shown to have little effect in management of genuine stress incontinence, although it may have a synergistic role when used with an α-adrenergic agonist. When considering the irritative urinary symptoms associated with urinary urgency and urge incontinence, oestrogen may be beneficialalthough this may simply reflect a reversal of urogenital atrophy rather than a direct effect on the lower urinary tract. Finally, oestrogens would appear to be efficacious in the management of recurrent lower urinary tract infections, with the most convincing evidence being in support of local vaginal administration.