HORMONAL TREATMENT IN UROGYNECOLOGY
Abstract
Background. Hormonal treatment in urogynecology is based on the knowledge, that urinary and reproductive tracts have common embriologic origin and are also linked anatomically and functionally. Both systems are functioning and changing due to sex steroids influence. Decreased estrogen concentrations are connected to metabolic and trophic changes in all organs with estrogen receptors, i.e. also in urogenital tract. Atrophy of urogenital system in postmenopause is a common causative factor for stress urinary incontinence (SUI) and urge incontinence (UUI). In both estrogen replacement treatment have been introduced, but meta-analyses of the available literature indicate that estrogen therapy is effective only if given vaginaly. Recurrent urinary tract infections (RUTI) occur in postmenopause often as a consequence of structural changes in urinary and reproductive tract to lowered immune protection and colonization with eneterobacteria. In RUTI too, estrogen replacement treatment have been used with the results similar to those with SUI and UUI. Effectiveness of estrogen treatment was evident only in topically applied vaginaly, while oral administration has the same effectiveness as placebo.
Conclusions. Structural changes in urogenital tract in postmenopause are the results of estrogen depletion. Estrogen replacement is effective in cases of SUI, UUI and RUTI if it is applied topicaly, the efffect being influenced by the type of estrogen used and duration of treatment.
Downloads
References
Batra SC, Josif CS. Female urethra: a target for estrogen action.
J Urol 1983; 129: 418–20.
Blakeman PS, Hilton P, Bulmer JN. Oestrogen and progesteron
receptor expression in the female lower urinary tract, with reference
to oestrogen status. BJU Int 2000; 86: 32–8.
Moehrer B, Hextall A, Jackon S. Oestrogen for urinary incontinence
in women. Cochrane Database Syst Rev 2003; CD
Van Geelen JM, Doesburg WH, Thomas CM, Martin CB. Urodynamic
studies in the normal menstrual cycle: the relationship
between hormonal changes during the menstrual cycle in
the urethral pressure profile. Am J Obstet Gynecol 1981; 141:
–92.
Cardoso L, Lose G, Mc Clich D, Versi E, De Konning-Gan S. A
systematic review of estrogens for recurrent urinary tract infections:
third report of The hormones and urogenital therapy
(HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct 2001;
: 15–20.
Loose G, Englev E. Oestradiol-releasing vaginal ring versus oestriol
vaginal pessaries in the treatment of bothersome lower urinary
tract symptoms. Br J Obstet Gynecol 2000; 107: 1029–34.
Falconer C, Blomgren B, Johansson O, Ulmsten U, Malmström A,
Westergren-Thorsson G, et al. Different organization of collagen
fibries in stress incontiennce women of fertile age. Acta Obstet
Gynecol Scand 1998; 77: 87–94.
Cör A, Barbič M, Kralj B. Differences in the quantity of elastic
fibres and collagen type I and type III in endopelvic fascia between
women with stress urinary incontinence and controls.
Urol Res 2003; 31: 61–5.
Falconer C, Ekman-Ordeberg G, Blomgren B, Johansson O,
Ulmsten U, Westergren-Thorsson G, et al. Paraurethral connective
tissue in stres incontinence women after menopause. Acta
Obstet Gynecol Scand 1998; 77: 95–100.
Jackon S, James M, Abrams P. The effect of estradiol on vaginal
collagen metabolism in postmenopausal women with genuine
stress incontinence. Br J Obstet Gynecol 2002; 109: 339–44.
Cardoso L, Lose G, Mc Clich D, Versi E. A systemic review of
the effects of estrogen for symptoms suggestive of overactive
bladder. Acta Obstet Gynecol Scand 2004; 83: 892–7.
Bernstein IT. The pelvic floor muscles thickness in healthy and
urinary incontinence women measured by perineal ultrasonography
with reference to the efect of pelvic floor training. Estrogen
receptor studies. Neurourol Urodyn 1997; 16: 237–75.
Smith P, Heimer G, Norgren A, Ulmsten U. Localisation of steroid
hormone receptors in the pelvic muscles. Eur J Obstet Gynecol
Reprod Biol 1993: 50: 83–5.
Grady D, Brown JS, Vittinghoff E, Applegate W, Varner E, Snyder
T. Postmenopausal hormones and incontinence: The Heart and
Estrogen/Progestin Replacement Study. Obstet Gynecol 2001;
: 116–20.
Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM,
Iglesia C. Effects of estrogen with and withouot progesteron on
urinary incontinence. JAMA 2005; 293: 935–48.
Fu X, Rezapour M, Wu X, Li L, Sjogren C, Ulmsten U. Expression
of estrogen receptor – alpha and beta in anterior vaginal walls
of genuine stress incontinence women. Int Urogynecol J Pelvic
Floor Dysfunct 2003; 14: 276–81.
Brown JS, Grady D, Ouslander JG, Herzog AR, Varner RE, Posner
SF. Prevelances of urinary incontiennce and associated risk factors
in postmenopausal women. Heart and estrogen/progestin
replacement stufy (HERS). Research Group. Obstet Gynecol
; 94: 66–70.
Hirai K, Tsuda H. Estrogens and urinary incontinence. Int J Urol
; 16: 45–8.
Lukanovič A. Lokalno hormonsko zdravljanje pri mikcijskih motnjah
v pomenopavzi. Zdrav Vestn 2008; 77 Suppl 3: III-59–64.
Hextall A. The effect of estrogen and the menopause on the
female lower urinyra tract. MD Thesis. London: University of
London; 2001.
Cardoso LD, Wise BG, Bennes CJ. Vaginal oestradiol for the
treatment of lower urinary tract symptoms in postmenopausal
women – a double blind placebo controlled study. J Obstet
Gynecol 2001; 21: 383–5.
Car J. Urinary tract infections in women: diagnosis and management
in primary care. BMJ 2006; 332: 94–7.
Kucheria R, Dasgupta P, Sacks S, Khan M, Sheerin N. Urinary
tract infections: new insight into a common problem. Postgrad
Med J 2005; 81: 83–6.
Hu K, Boyko EJ, Scholes D, Normand E, Chen CL, Grafton J, et
al. Risk factors for urinary tract infection in postmenopausal
women. Arch Inter Med 2004; 164: 989–93.
Harding GKM, Ronald AR. A controlled study of antimicrobial
prophylaxis of recurrent urinary infection in women. N Eng J
Med 1974; 291: 597–601.
Fihn SD. Acute uncomplicated urinary tract infection in women.
N Eng J Med 2003; 349: 259–66.
Raz R, Stamm WE. A controlled trial of intravaginal estriol in
postmenopausal women with recurrent urinary tract infection.
N Eng J Med 1993; 329: 753–6.
Raz R, Colodner RR, Rohana Y, Battino S, Rottensterich E, Wasser
I, et al. Effectiveness of estriol-containing vaginal pessaries
and nitrofurantoin macrocrystal therapy in the prevention of
recurrent urinary tract infection in postmenopausal women.
Clin Infect Dis 2003; 36: 1362–8.
Perrota C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogen for
preventing recurrent urinary tract infection in postmenopausal
women. Cochrane Database Syst Rev 2008; CD 005131.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
