The role of estrogens in female lower urinary tract dysfunction.
The urogenital tract and lower urinary tract are sensitive to the effects of estrogen and progesterone throughout adult life. Epidemiologic studies have implicated estrogen deficiency in the etiology of lower urinary tract symptoms that occur after menopause. Although the role of estrogen replacement therapy in the management of postmenopausal urinary incontinence (UI) remains controversial, its use in the treatment of women with urogenital atrophy is now well established. This review summarizes recent evidence of the urogenital effects of hormone therapy, particularly emphasizing management of postmenopausal UI and recurrent lower urinary tract infections. Estrogen therapy alone has little effect in the management of urodynamic stress UI, although in combination with an alpha-adrenergic agonist, it may improve urinary leakage. Estrogen therapy may be of benefit for the irritative symptoms of urinary urgency, frequency, and urge UI, although this effect may result from reversal of urogenital atrophy rather than a direct action on the lower urinary tract. The role of estrogen replacement therapy in the treatment of women with recurrent lower urinary tract infections remains to be determined, although there is now some evidence that vaginal administration may be efficacious. Low-dose, vaginally administered estrogens have a role in the treatment of urogenital atrophy in postmenopausal women and appear to be as effective as systemic preparations.
Robinson
Dudley
D
Department of Urogynaecology, King's College Hospital, London, United Kingdom. dud@ukgateway.net
Cardozo
Linda D
LD
D000282:Administration, Intravaginal; D000328:Adult; D000368:Aged; D001284:Atrophy; D002986:Clinical Trials as Topic; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000008:administration & dosage / Q000502:physiology* / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D011372:Progestins / Q000627:therapeutic use; D011987:Receptors, Steroid / Q000187:drug effects / Q000502:physiology; D012008:Recurrence; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology / Q000627:therapeutic use; D014549:Urinary Incontinence / Q000188:drug therapy / Q000503:physiopathology; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control; D014555:Urination Disorders / Q000188:drug therapy / Q000503:physiopathology*; D019459:Urothelium / Q000473:pathology
D004967:Estrogens; D011372:Progestins; D011987:Receptors, Steroid; D020845:Selective Estrogen Receptor Modulators