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Published on June 15, 2020

Local Estrogen Replacement for Urinary Incontinence as Related to Urogenital Atrophy

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Adequate levels of estrogen inside the walls of your urethra are essential for these walls to be strong enough to maintain continence (bladder control) along with the urethral sphincter muscle. Perimenopause, the time in a woman’s life in which the hormone that stimulates an egg to be released from the ovaries (follicle stimulating hormone), may start to increase while estrogen levels begin to decrease, and may be what starts urinary continence changes.

Menopause is understood to be complete when there have been no menstrual cycles for at least 12 months. These changes in the hormone levels cause thinning and dryness of vaginal and urethral tissue, which is also called genital atrophy. Urogenital means the female organs and urinary tract, and atrophy means decreasing in size and ability to function.

The primary concern that patients may have about estrogen replacement may be the use of local or systemic estrogen replacement may be the conflicting reports in the media as to a possible link between breast cancer, heart disease and estrogen replacement. A discussion with the physician will help you determine what is the best for you and your situation.

Symptoms You May Notice:

  • A feeling of “dryness” in and around the vaginal area
  • Irritation after sexual relations
  • Urgency, the need to empty the bladder quickly
  • Frequency, the need to empty the bladder often
  • Urge incontinence, when urine leaks out of the bladder when the need to empty the bladder is felt
  • Urinary tract infections
  • Stress incontinence, the leaking of urine with coughing, sneezing or laughing

Signs the Physician May find on Examination:

  • The vaginal tissues appear thin, shiny and very fragile
  • Urinary incontinence when you cough or bear down
  • Bacteria in your urine

Treatment

Currently, both estrogen to the vaginal area alone or in combination with ERT (estrogen replacement therapy) or HRT (estrogen and progesterone replacement therapy) is considered very beneficial in reducing the signs and symptoms noted above. The amount of drug prescribed will be on individual basis. Current forms of local estrogen replacement include:

  • Vaginal cream applied by wither an applicator or with finger tip application
  • Vaginal ring placed in the vagina and changed every 90 days
  • Vaginal suppositories placed into the vagina 2 times per week and eventually going down to 1 time per week

Prevention

There is no known way to prevent this from happening, as it occurs in most women who experience menopausal.

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