JOGC

Managing Menopause Chapter 5 Urogenital Health

        The vagina, lower urinary tract, and pelvic floor have the same embryologic origin, and therefore all contain estrogen receptors and undergo atrophy in the estrogen-deficient state of menopause. The concept of urogenital aging encompasses the altered structure and function of the urogenital tissues under the combined influence of estrogen loss from menopause and tissue aging. Although tissue aging is both insidious and inevitable, the effect of estrogen loss on the urogenital tissues is relatively rapid and, at least to some extent, reversible with ET.
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        REFERENCES

          • Oriba H.A.
          • Maibach H.I.
          Vulvar transepidermal water loss (TEWL) decay curves. Effect of occlusion, delipidation, and age.
          Acta Derm Venereol. 1989; 69: 461-465
          • Iosif C.S.
          • Bekassy Z.
          Prevalence of genito-urinary symptoms in the late menopause.
          Acta Obstet Gynecol Scand. 1984; 63: 257-260
          • Pastore L.M.
          • Carter R.A.
          • Hulka B.S.
          • Wells E.
          Self-reported urogenital symptoms in postmenopausal women: Women’s Health Initiative.
          Maturitas. 2004; 49: 292-303
          • Dennerstein L.
          • Dudley E.C.
          • Hopper J.L.
          • Guthrie J.R.
          • Burger H.G.
          A prospective population-based study of menopausal symptoms.
          Obstet Gynecol. 2000; 96: 351-358
          • Kalogeraki A.
          • Tamiolakis D.
          • Relakis K.
          • Karvelas K.
          • Froudarakis G.
          • Hassan E.
          • et al.
          Cigarette smoking and vaginal atrophy in postmenopausal women.
          In Vivo. 1996; 10: 597-600
          • Ganz P.A.
          • Greendale G.A.
          • Petersen L.
          • Zibecchi L.
          • Kahn B.
          • Belinet T.R.
          Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial.
          J Natl Cancer Inst. 2000; 92: 1054-1064
          • Moegele M.
          • Buchholz S.
          • Seitz S.
          • Ortmann O.
          Vaginal estrogen therapy in postmenopausal breast cancer patients treated with aromatase inhibitors.
          Arch Gynecol Obstet. 2012; 285 (Epub 2012 Jan 3): 1397-1402
          • Baumgart J.
          • Nilsson K.
          • Stravreus-Evers A.
          • Kask K.
          • Villman K.
          • Lindman H.
          • et al.
          Urogenital disorders in women with adjuvant endocrine therapy after early breast cancer.
          Am J Obstet Gynecol. 2011; 204 (Epub 2010 Oct 14): 26.e1-26.e7
          • Stenberg A.
          • Heimer G.
          • Ulmsten U.
          • Cnattingius S.
          Prevalence of genitourinary and other climacteric symptoms in 61-year-old women.
          Maturitas. 1996; 24: 31-36
          • Hickey M.
          • Saunders C.
          • Partridge A.
          • Santoro N.
          • Joffe H.
          • Stearns V.
          Practical clinical guidelines for assessing and managing menopausal symptoms after breast cancer.
          Ann Oncol. 2008; 19 (Epub 2008 Jun 2): 1669-1680
          • Nappi R.E.
          • Kokot-Kierepa M.
          Vaginal health: insights, views and attitudes (VIVA) — results from an international survey.
          Climacteric. 2012; 15: 36-44
          • Nachtigall L.E.
          Comparative study: replens versus local estrogen in menopausal women.
          Fertil Steril. 1994; 61: 178-180
          • Bygdeman M.
          • Swahn M.L.
          Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women.
          Maturitas. 1996; 23: 259-263
          • Nikander E.
          • Rutanen E.M.
          • Neiminen P.
          • Wahlstrom T.
          • Ylikorkala O.
          • Tiitinen A.
          Lack of effect of isoflavonoids on the vagina and endometrium in postmenopausal women.
          Fertil Steril. 2005; 83: 137-142
          • Le Donne M.
          • Caruso C.
          • Mancuso A.
          • Costa G.
          • Iemmo R.
          • Pizzimenti G.
          • et al.
          The effect of vaginally administered genistein in comparison with hyaluronic acid on atrophic epithelium in postmenopause.
          Arch Obstet Gynecol. 2011; 283 (Epub 2010 Jun 25): 1319-1323
          • Leach M.J.
          • Moore V.
          Black cohosh (Cimicifuga spp.) for menopausal symptoms.
          Cochrane Database Syst Rev. 2012; 9: CD007244
          • Hirata J.D.
          • Swiersz L.M.
          • Zell B.
          • Small R.
          • Ettinger B.
          Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.
          Fertil Steril. 1997; 68: 981-986
          • Yildirim B.
          • Kaleli B.
          • Duzcan E.
          • Topuz O.
          The effects of postmenopausal vitamin D treatment on vaginal atrophy.
          Maturitas. 2004; 49: 334-337
          • Biglia N.
          • Peano E.
          • Sgandurra P.
          • Moggio G.
          • Panuccio E.
          • Migliardi M.
          • et al.
          Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study.
          Gynecol Endocrinol. 2010; 26: 404-412
          • Cardozo L.D.
          • Bachmann G.
          • McClish D.
          • Fonda D.
          • Birgerson L.
          Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the hormone and urogenital therapy committee.
          Obstet Gynecol. 1998; 92: 722-727
          • Johnston S.L.
          • Farrell S.A.
          • SOGC Clinical Practice Gynaecology and Urogynaecology Joint Committee
          The detection and management of vaginal atrophy. SOGC Clinical Practice Guidelines, No. 145, May 2004.
          Int J Gynaecol Obstet. 2005; 88: 222-228
          • Suckling J.A.
          • Kennedy R.
          • Lethaby A.
          • Roberts H.
          Local oestrogen for vaginal atrophy in postmenopausal women.
          Cochrane Database Syst Rev. 2006; 4 (CD001500.pub2.)
          • Raz R.
          • Stamm W.
          A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.
          N Engl J Med. 1993; 329: 753-756
          • Raz R.
          Hormone replacement therapy or prophylaxis in postmenopausal women with recurrent urinary tract infection.
          J Infect Dis. 2001; 183: 74-76
          • Eriksen B.
          A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women.
          Am J Obstet Gynecol. 1999; 180: 1072-1079
          • Ayton R.
          • Darling G.
          • Murkies A.
          • Farrell E.
          • Weisberg E.
          • Selinus I.
          • et al.
          A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy.
          Br J Obstet Gynaecol. 1996; 103: 351-358
          • Rigg L.A.
          • Milanes B.
          • Villanueva B.
          • Yen S.S.
          Efficacy of intravaginal and intranasal administration of micronized estradiol-17beta.
          J Clin Endocrinol Metab. 1997; 45: 1261-1264
          • Pschera H.
          • Hjerpe A.
          • Carlstrom K.
          Influence of the maturity of the vaginal epithelium upon the absorption of vaginally administered estradiol-17 beta and progesterone in postmenopausal women.
          Gynecol Obstet Invest. 1989; 27: 204-207
          • Eugster-Hausmann M.
          • Waitzinger J.
          • Lehnick D.
          Minimized estradiol absorption with ultra-low-dose 10 microg 17beta-estradiol vaginal tablets.
          Climacteric. 2010; 13: 219-227
          • Rioux J.E.
          • Devlin M.C.
          • Gelfand M.M.
          • Steinberg W.M.
          • Hepburn D.S.
          17-β-estradiol vaginal tablets versus conjugated equine estrogen cream to relieve menopausal atrophic vaginitis.
          Menopause. 2000; 7: 156-161
          • Mettler L.
          • Olsen P.G.
          Long-term treatment of atrophic vaginitis with low-dose oestradiol vaginal tablets.
          Maturitas. 1991; 14: 23-31
          • Weiderpass E.
          • Baron J.A.
          • Adami H.O.
          • Magnusson C.
          • Lindgren A.
          • Bergström R.
          • et al.
          Low-potency oestrogen and risk of endometrial cancer: a case-control study.
          Lancet. 1999; 353: 1824-1828
          • Kendall A.
          • Dowsett M.
          • Folkerd E.
          • Smith I.
          Caution: vaginal estradiol appears to be contraindicated in postmenopausal women on adjuvant aromatase inhibitors.
          Ann Oncol. 2006; 17: 584-587
          • Dew J.E.
          • Wren B.G.
          • Eden J.A.
          A cohort study of topical vaginal estrogen therapy in women previously treated for breast cancer.
          Climacteric. 2003; 6: 45-52
          • Le Ray I.
          • Dell’Aniello S.
          • Bonnetain F.
          • Azoulay L.
          • Suissa S.
          Local estrogen therapy and risk of breast cancer recurrence among hormone-treated patients: a nested case-control study.
          Breast Cancer Res Treat. 2012; 135 (Epub 2012 Aug 19): 603-609
          • North American Menopause Society
          The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society.
          Menopause. 2007; 14: 355-369
          • Witherby S.
          • Johnson J.
          • Demers L.
          • Mount S.
          • Littenberg B.
          • Maclean C.D.
          • et al.
          Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study.
          Oncologist. 2011; 16 (Epub 2011 Mar 8): 424-431
          • Derzko C.
          • Elliot S.
          • Lam W.
          Management of sexual dysfunction in postmenopausal breast cancer patients taking adjuvant aromatase inhibitor therapy.
          Curr Oncol. 2007; 14: S20-S40
          • Shelley W.
          • Draper M.W.
          • Krishnan V.
          • Wong M.
          • Jaffe R.B.
          Selective estrogen receptor modulators: an update on recent clinical findings.
          Obstet Gynecol Surv. 2008; 63: 163-181
          • Simon J.A.
          • Lin V.H.
          • Radovich C.
          • Bachmann G.A.
          • Ospemifene Study Group
          One-year long-term safety extension study of ospemifene for the treatment of vulvar and vaginal atrophy in postmenopausal women with a uterus.
          Menopause. 2013; 20: 418-427
          • Goldstein S.R.
          • Cummings S.R.
          • Eastell R.
          • Ensrud K.
          • Tan O.
          • Bradshaw K.
          • et al.
          Vaginal effects of lasofoxifene: 3-year results from the PEARL Trial.
          Menopause. 2008; 15: 1228-1229
          • Labrie F.
          • Cusan L.
          • Gomez J.L.
          • Côté I.
          • Bérubé R.
          • Bélanger P.
          • et al.
          Effect of intravaginal DHEA on serum DHEA and eleven of its metabolites in postmenopausal women.
          J Steroid Biochem Mol Biol. 2008; 111 (Epub 2008 Jun 12): 178-194
          • Labrie F.
          • Archer D.
          • Bouchard C.
          • Fortier M.
          • Cusan L.
          • Gomez J.L.
          • et al.
          High internal consistency and efficiency of intravaginal DHEA for vaginal atrophy.
          Gynecol Endocrinol. 2010; 26: 524-532
          • Cerruto M.A.
          • D’Elia C.
          • Aloisi A.
          • Fabrello M.
          • Artibani W.
          Prevalence, incidence and obstetric factors’ impact on female urinary incontinence in Europe: a systematic review.
          Urol Int. 2013; 90 (Epub 2012 Aug 3): 1-9
          • Subak L.L.
          • Brown J.S.
          • Kraus S.R.
          • Brubaker L.
          • Lin F.
          • Richter H.E.
          • Diagnostic Aspects of Incontinence Study Group
          • et al.
          The “costs” of urinary incontinence for women.
          Obstet Gynecol. 2006; 107: 908-916
          • Jarmy-Di Bella Z.I.
          • Girao M.J.
          • Di Bella V.
          • Sartori M.G.
          • Szejnfeld J.
          • Baracat E.C.
          • et al.
          Hormonal influences on periurethral vessels in postmenopausal incontinent women using Doppler velocimetry analysis.
          Maturitas. 2007; 56: 297-302
          • Nelken R.S.
          • Ozel B.Z.
          • Leegant A.R.
          • Felix J.C.
          • Mishell Jr., D.R.
          Randomized trial of estradiol vaginal ring versus oral oxybutynin for the treatment of overactive bladder.
          Menopause. 2011; 18: 962-966
          • Abrams P.
          • Andersson K.E.
          • Birder L.
          • Brubaker L.
          • Cardozo L.
          • Chapple C.
          • et al.
          Fourth International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence.
          Neurourol Urodyn. 2010; 29: 213-240
          • Brown J.S.
          • Vittinghoff E.
          • Kanaya A.M.
          • Agarwal S.K.
          • Hulley S.
          • Foxman B.
          Heart and Estrogen/Progestin Replacement Study Research Group. Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors.
          Obstet Gynecol. 2001; 98: 1045-1052
          • Cody J.D.
          • Jacobs M.L.
          • Richardson K.
          • Moehrer B.
          • Hextall A.
          Oestrogen therapy for urinary incontinence in post-menopausal women.
          Cochrane Database Syst Rev. 2012; 10: CD001405
          • Botlero R.
          • Davis S.R.
          • Urquhart D.M.
          • Shortreed S.
          • Bell R.J.
          Age-specific prevalence of, and factors associated with, different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire.
          Maturitas. 2009; 62 (Epub 2009 Jan 31): 134-139
          • Waetjen L.E.
          • Ye J.
          • Feng W.Y.
          • Johnson W.O.
          • Greendale G.A.
          • Sampselle C.M.
          • Study of Women’s Health Across the Nation (SWAN)
          • et al.
          Association between menopausal transition stages and developing urinary incontinence.
          Obstet Gynecol. 2009; 114: 989-998
          • Subak L.L.
          • Johnson C.
          • Whitcomb E.
          • Boban D.
          • Saxton J.
          • Brown J.S.
          Does weight loss improve incontinence in moderately obese women?.
          Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13: 40-43
          • Townsend M.K.
          • Danforth K.N.
          • Rosner B.
          • Curhan G.C.
          • Resnick N.M.
          • Grodstein F.
          Body mass index, weight gain, and incident urinary incontinence in middle-aged women.
          Obstet Gynecol. 2007; 110: 346-353
          • Johnston S.
          Urogenital concerns. In: Canadian Consensus Conference on Menopause, 2006 update. SOGC Clinical Practice Guidelines, No. 171, February 2006.
          J Obstet Gynaecol Can. 2006; 28: S33-S42
          • Peattie A.B.
          • Plevnik S.
          • Stanton S.L.
          Vaginal cones: a conservative method of treating genuine stress incontinence.
          Br J Obstet Gynaecol. 1988; 95: 1049-1053
          • Sand P.K.
          • Richardson D.A.
          • Staskin D.R.
          • Swift S.E.
          • Appell R.A.
          • Whitmore K.E.
          • et al.
          Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: a multicenter, placebo-controlled trial.
          Am J Obstet Gynecol. 1995; 173: 72-79
          • Donnelly M.J.
          • Powell-Morgan S.
          • Olsen A.L.
          • Nygaard I.E.
          Vaginal pessaries for the management of stress and mixed urinary incontinence.
          Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15: 302-307
          • Farrell S.A.
          • Singh B.
          • Aldakhil L.
          Continence pessaries in the management of urinary incontinence in women.
          J Obstet Gynaecol Can. 2004; 26: 113-117
          • Nabi G.
          • Cody J.D.
          • Ellis G.
          • Hay-Smith J.
          • Herbison G.P.
          Anticholinergic drugs versus placebo for overactive bladder syndrome in adults.
          Cochrane Database Syst Rev. 2009; 1: CD003781
          • Robert M.
          • Ross S.
          • SOGC Urogynaecology Committee
          Conservative management of urinary incontinence.
          J Obstet Gynaecol Can. 2006; 28: 1113-1118
          • Alhasso A.A.
          • McKinlay J.
          • Patrick K.
          • Stewart L.
          Anticholinergic drugs versus non-drug active therapies for overactive bladder syndrome in adults.
          Cochrane Database Syst Rev. 2006; 2: CD003193
          • Geoffrion R.
          Treatments for overactive bladder: focus on pharmacotherapy.
          J Obstet Gynaecol Can. 2012; 34: 1092-1101