Menopause and its effect on the female lower urinary tract

Significant hormonal changes occur at the time of menopause and this has an impact on all oestrogen-sensitive tissue. The female lower urinary tract (LUT) is no exception. Decreasing levels of oestrogen characteristic of the menopause produce symptomatic, histological and functional changes of the vulva, vagina and lower urinary tract together. Examples of specific urogenital problems include urgency, urinary incontinence and susceptibility to urinary tract infection. Oestrogen therapy works by preventing or reversing urogenital atrophy and provides symptomatic improvement although it may need to be combined with other treatments for certain conditions such as incontinence. Oestrogen therapy requires time to become effective with vaginal preparations probably superior to systemic therapy. Prophylactic oestrogen therapy has not been shown to be clearly of benefit for specific types of urinary incontinence.