ABSTRACT

Urogenital atrophy is a manifestation of estrogen withdrawal following the menopause and symptoms may appear for the first time more than 10 years after the last menstrual period1. The female genital and lower urinary tract share a common embryological origin from the urogenital sinus and both are sensitive to the effects of female sex steroid hormones. Estrogen is known to have an important role in the function of the lower urinary tract throughout adult life and estrogen and progesterone receptors have been demonstrated in the vagina, urethra, bladder and pelvic floor musculature2-5. Estrogen deficiency occurring following the menopause is known to cause atrophic changes within the urogenital tract6 and is associated with urinary symptoms, such as frequency, urgency, nocturia, incontinence and recurrent infection. These may co-exist with symptoms of vaginal atrophy, such as dyspareunia, itching, burning and dryness. The role of estrogen replacement in the treatment of these symptoms of urogenital atrophy has still not been clearly defined despite several randomized trials and widespread clinical use. This review presents an overview of the pathogenesis and management of urogenital atrophy.