Nocturia through the menopausal transition and beyond: a narrative review

Abstract

Introduction and hypothesis Nocturia, defined as the act of waking to pass urine during sleeping, is a common problem in older women and is associated with significant morbidity and impairments in health-related quality of life. The aim of this review was to synthesize the current evidence regarding the incidence, impact, pathophysiology, and specific diagnostic approach of nocturia in the postmenopausal population. Methods We searched PubMed and Web of Science databases to identify relevant studies published through June 2020. Reference lists of the reviews obtained were screened for other articles deemed pertinent by the authors. Results Genitourinary symptoms attributed to the menopause have been reported to occur in nearly 90% of postmenopausal women, and nocturia is one of the most common. The relative deficiency in endogenous estrogen production after the menopause is thought to exacerbate all major pathophysiological mechanisms that may underlie nocturia, including reduced bladder capacity, nocturnal polyuria, global polyuria, and sleep disorders. Diminished estrogen may induce anatomical and physiological bladder changes, contributing to a reduction in functional bladder capacity. Excess nocturnal urine production can also be provoked by estrogen depletion, either via free water-predominant diuresis by an impaired secretion of antidiuretic hormone, or a salt-predominant diuresis owing to diminished activation of the renin-angiotensin-aldosterone axis. Additionally, a relationship between the transition to menopause and impaired sleep has been described, mediated by increased incidence in vasomotor symptoms and obstructive sleep apnea signs during the menopause. Conclusion Further research is necessary to better characterize and manage nocturia in postmenopausal women.

Mechanisms and Associated Factors of Nocturia in Women Attending Two Urogynecology Clinics: A Cross-Sectional Study

“…Moon et al (2019) even found a positive association between increasing body mass index and the likelihood of having two or more voids in adjusted analyses for age, sex, and various comorbidities [31]. The association found between normal body mass index and polyuria may be related to factors that were not part of the scope of the present study, such as the measurement of fluid intake in the bladder diary, as well as the hormonal status of the participants related to menopause [9].…”

“…According to the literature, these mentioned conditions are known to be associated with nocturia. The most commonly used medications were angiotensin II receptor blockers (44.7%), diuretics, and hypoglycemic agents (both 29.5%) [9] [10] [11] [12].…”

“…The causes of nocturia can be urological, such as overactive bladder syndrome [7] and underactive bladder [8], as well as non-urological. The latter largely involve alterations in water or sodium homeostasis, such as endocrine [9], cardiovascular [10], sleep [11], and renal pathologies, as well as the medications used in their treatment [12]. There are also associated factors, such as older age, lower income, and lower education level [4].…”

Canadian Urological Association best practice report: Diagnosis and management of nocturia

“…29 In peri-/post-menopausal women, hot flashes may contribute to sleep disturbances, and these can be managed by cooling techniques such as cold packs and changes to sleepwear and the environment (e.g., bedroom fan, air conditioning). 98 Avoidance of alcohol and spicy or hot foods is also beneficial in these patients. 99 © 2022 Canadian Urological Association Recommendation: Patients with nocturia should be screened for OSA, and the need for further evaluation, management, or specialist referral can be determined by the primary care provider (strong recommendation, very low level of evidence).…”

Nocturia due to nocturnal polyuria (NP). A common disorder

“…Furthermore, the importance of taking sleep into account should be emphasized when assessing the relationship between nocturia and associated outcomes (16). Another critical element to be highlighted is that despite traditionally regarding nocturia as a pronominally male condition, robust data support the evidence that it is just as prevalent in women as in men and especially in postmenopausal women (12,17). The importance of the 'frequency-volume chart,' a very simple exam, has to be underlined as the main tool to guide diagnosis and identify the appropriate treatment of nocturia.…”