The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence

Jackson, S

doi:10.1016/s1470-0328(02)01052-2

Cited by 31 publications

(36 citation statements)

References 27 publications

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“…Estrogen deficiency causes atrophic changes in the bladder trigone, decreased tension of muscular and connective structures of the urogenital diaphragm, disorders of collagen metabolism and decreased activity of the a-adrenergic system innervating both the bladder neck and urethral sphincter 29 . The urethral mucosa, also estrogen-sensitive, becomes thinner along with its submucosal vascular plexus.…”

Section: Physical Signsmentioning

confidence: 99%

Recommendations for the management of postmenopausal vaginal atrophy

2010

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Unlike hot flushes and night sweats which resolve spontaneously in time, atrophic symptoms affecting the vagina and lower urinary tract are often progressive and frequently require treatment. The prevalence of vaginal dryness increases as a woman advances through the postmenopausal years, causing itching, burning and dyspareunia, and sexual activity is often compromised. But, despite the various safe and effective options, only a minority (about 25% in the Western world and probably considerably less in other areas) will seek medical help. Some of this reluctance is due to the adverse publicity for hormone replacement therapy (HRT) over recent years that has suggested an increased risk of breast cancer, heart disease and stroke. But, regardless of whether these scares are justified, local treatment of vaginal atrophy is not associated with these possible risks of systemic HRT. Other reasons for the continued suffering in silence may be cultural and an understandable reluctance to discuss such matters, particularly with a male doctor, but the medical profession must also take much of the blame for failing to enquire of all postmenopausal women about the possibility of vaginal atrophic symptoms. Vaginal dryness can be helped by simple lubricants but the best and most logical treatment for urogenital atrophy is to use local estrogen. This is safe, effective and with few contraindications. It is hoped that these guidelines and recommendations, produced to coincide with World Menopause Day 2010, will help to highlight this major cause of distress and reduced quality of life and will encourage women and their medical advisers all over the world to seek and provide help.

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Section: Physical Signsmentioning

confidence: 99%

Recommendations for the management of postmenopausal vaginal atrophy

2010

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“…Indeed, several possible mechanisms have been proposed. For example, observed decreases in paraurethral collagen concentration and cross-linking6, 7, increases in mRNA levels for collagen types I and III6, and increased matrix metalloproteinase-2 activity7 in women taking estrogen therapy indicate increased collagen turnover, and suggest that estrogen supplementation may weaken the structure of the connective tissues supporting the urethra. In addition, animal studies have found increases in the smooth muscle to collagen ratio, vascular density, and contractility of the bladder with estrogen supplementation 8, 9.…”

Section: Commentmentioning

confidence: 99%

“…Yet, recent data from large-scale prospective studies, including randomized trials, have demonstrated increased risks of incident urinary incontinence (UI) and worsening UI severity among women using hormone therapy 2–5. A positive association between hormone therapy and the risk of stress UI may be explained by estrogen’s role in decreasing the collagen concentration of the connective tissues supporting the urethra6, 7 while increasing bladder contractility 8, 9. In addition, it is possible that adverse neurovascular effects of hormone therapy10, 11 result in damage to bladder innervation and lead to urge UI.…”

Section: Introductionmentioning

confidence: 99%

Postmenopausal hormone therapy and incident urinary incontinence in middle-aged women

Townsend

Curhan

Resnick

et al. 2009

American Journal of Obstetrics and Gynecology

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Objective-To examine the association of hormone therapy with incident urinary incontinence (UI) in postmenopausal women aged 37-54 years in the Nurses' Health Study II. Results-Women currently using hormone therapy had 1.39-fold (95% CI 1.16-1.67) increased odds of incident UI compared with women who never used hormone therapy. Odds ratios were similar in current users of oral estrogen alone (OR 1.35, 95% CI 1.03-1.78) and oral estrogen with progestin (OR 1.37, 95% CI 1.13-1.67).Conclusion-These findings suggest an increased risk of UI associated with use of postmenopausal hormone therapy in younger postmenopausal women.

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“…In addition, although our observation of an increase in odds of stress UI among nulliparous women using OCPs was a sub-group analysis and should be interpreted cautiously, this result may be attributed to mechanisms similar to those proposed for postmenopausal hormone therapy in stress UI 2, 3. Specifically, hormone therapy has been associated with an increase in collagen turnover,14, 15 which may lead to an increased risk of stress UI development. In premenopausal women, these factors may be notable only in nulliparous women, whose risk of stress UI is not primarily determined by childbirth.…”

Section: Discussionmentioning

confidence: 99%

Oral Contraceptive Use and Incident Urinary Incontinence in Premenopausal Women

et al. 2009

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Purpose Recent data in postmenopausal women indicate that current and past use of exogenous hormones is related to urinary incontinence (UI) risk. Little is known about exogenous hormones and UI risk in younger women. We investigated the association between oral contraceptive pills (OCPs) and incident UI in premenopausal women enrolled in the Nurses' Health Study II. Materials and Methods Participants reported use of OCPs from 1989 to 2001. Among 21,864 premenopausal women, aged 37-54 years, reporting no UI in 2001, we identified 749 cases with incident UI at least weekly between 2001 and 2003. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Results Women who had ever used OCPs had statistically significant 27% (95% CI 1-59%) increased odds of developing UI at least weekly compared with women who never used OCPs. Among women with 10 or more years of use, the odds ratio increased to 1.48 (95% CI 1.13-1.95). Ever use of OCPs was specifically associated with urgency UI (OR 2.48, 95% CI 1.07-5.76) and not stress UI (OR 1.04, 95% CI 0.78-1.40). Although we had limited information on urinary tract infection, control for urinary tract infection did not alter these findings. Conclusions Use of OCPs may be associated with a modest increase in odds of UI among premenopausal women. However, this is one of the first reports of such an association and thus, further research is needed to confirm our findings and investigate possible mechanisms.

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The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence

Cited by 31 publications

References 27 publications

Recommendations for the management of postmenopausal vaginal atrophy

Recommendations for the management of postmenopausal vaginal atrophy

Postmenopausal hormone therapy and incident urinary incontinence in middle-aged women

Oral Contraceptive Use and Incident Urinary Incontinence in Premenopausal Women

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