Uro-genital tissues and ESTROGEN

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From ESTROGEN: How and Why It Can Save Your Life, by Adam Romoff, M.D. and Ina Yalof. Urinary Problems Studies indicate that up to 40 percent of menopausal women have some form of urinary leakage, which is called urinary incontinence. Similar numbers of women complain of frequent urination, a sudden urge to urinate (even though the bladder is not full), and occasional painful urination. Making matters worse, fewer than half of incontinent women seek

help -- often because of embarrassment or the misconception that the condition is an inevitable consequence of aging. Urinary tract tissues in women are embryologically related to the genital tract. Estrogen RECEPTORS have been identified in the urethra and bladder, as well as in the muscles of the pelvis. Just as with the lining of the vagina, with menopause, the lining of the urethra may become thin, and the surrounding muscles and elastic tissues may weaken. Estrogen has been shown to enhance the tone of the urethra, allowing it to increase its pressure (think of the urethra as a straw squeezing itself shut) and hold back any undesired flow of urine from the bladder. Estrogen also allows the blood vessels in the urethra to become more swollen (from improved blood flow),

which somewhat helps compress the urethra to keep it closed. Given these findings and the known association of the postmenopausal years with increased urinary tract problems, it has been widely assumed that estrogen loss plays a major role in the development of these problems -- and that its replacement will cure them. Estrogen-replacement therapy does ease some urinary symptoms, but it stops well short of a cure. Though a substantial proportion of patients with urinary problems who take estrogen feel better when you measure their bladder function in a laboratory, estrogen users are not significantly different from nonusers. Why, then, are symptoms relieved by estrogen? One idea is that estrogen makes the bladder less sensitive to stimuli. Without estrogen, the bladder may

overreact with increased contractions -- creating an urge to urinate, or leading to an increased frequency of urination, especially at night. "Nocturia" (noct = nocturnal), can be particularly bothersome. By decreasing the sensitivity and "hyper" functioning of the bladder, there is less disruption of daily living. Another mechanism by which estrogen provides improvement is the prevention of urinary tract infections (which also cause a frequent urge to urinate). Unlike other urinary problems, the ability of estrogen to prevent these infections in menopausal women has unequivocal scientific support. Estrogen users have significantly fewer urinary tract infections, presumably because estrogen returns the vaginal environment to its original state, encouraging the return of lactobacilli, and removing the offending bacteria. Indeed,

compared to nonusers, many estrogen users remain free of urinary tract infection. In sum, regarding the urinary tract, estrogen may best be considered a role player, providing supportive therapy and improving comfort level. Still, all urinary complaints should receive prompt and expert attention. Proper diagnosis and individualized treatment-which may be a combination of medical, surgical, and behavioral therapy -- is essential.