Estrogen increases urethral resistance, raises the sensory  threshold of the bladder, increases adrenoreceptor sensitivity in the urethral smooth muscle, and promotes b3 adreneroceptor-mediated relaxation of the detrusor muscle. The detrusor muscle is the layer of involuntary muscle in the bladder wall. During urination, this muscle contracts to squeeze urine out of the bladder into the urethra. Symptoms of urogenital atrophy, a conditon caused by diminished estrogen affects close to forty percent of postmenopause women.

Vaginal estrogen cream, a vaginal estrogen tablet  and the vaginal estrogen ring are therapeutic options to help reverse postmenopausal atrophy of the vagina and/or lower urinary tract. These prescription products thicken the vaginal lining and increase its secretions by re-estrogenizing the vulva and vagina. Prescription vaginal estrogen preparations help vaginal tissue retain suppleness, resilience and moistness.

Vaginal cream or the vaginal ring also help treat urinary incontinence that stems from lack of estrogen. The urethra is the canal through which urine passes from the bladder to outside the body. The urethra is positioned under the top part of the vagina. Vaginal preparations enhance nerve function and blood supply to the urethra, which in turn increases muscle size and strength.

The vaginal ring contains 2 mg of 17 beta-estradiol. When placed in the vagina, the vaginal ring releases approximately 7.5 mcg of estradiol each 24 hours (only 8% of which is systemically absorbed). The vaginal ring has an outer diameter of about two inches and  can be self inserted or inserted by a health practitioner into the upper portion of the vagina. Body temperature allows the vaginal ring to slowly release a consistant, low dose of estrogen for ninety days.The vaginal ring can remain inserted during intercourse and bathing.

A multicenter study demonstrated that the ring produced a significant improvement in vaginal dryness, vulvar pruritus, dyspareunia, dysuria, and urinary urgency in more than 90% of the treatment group within 3 months and that the improvement was maintained over a year. Another study, demonstrated a significant reduction in urinary tract infections in postmenopausal women over a period of 36 weeks.

With use of the vaginal estrogen ring, systemic estradiol levels do not rise above postmenopausal levels (20-30 pmol/L), this making uterine tissue growth (endometrial proliferation) less likely. Several studies have established that a level greater than 60 pmol/L must be maintained to stimulate endometrial proliferation.

Vaginal cream contains 0.1 mg estradiol per gram of cream. Upon initiation the vaginal estrogen cream or tablet is used once daily for one or two weeks, then twice a week as needed. The vaginal tablet contains 25 mcg of estradiol in a disposable single use applicator.

The vaginal cream/tablet and the vaginal ring exert their effects locally on the lower uro-genital tract, allowing women who have only specific uro-genital symptoms of menopause to target their treatment. The low dose vaginal cream/tablet or the vaginal ring do not result an appreciable absorption of estrogen into the bloodstream or significant stimulation of the uterine lining (endometrium). Administration of a vaginal preparation results in one half to one fourth the serum estrogen values compared to equivalent oral doses.

Oral hormone estrogen replacement also helps reverse postmenopausal vaginal atrophy. Most (but not all) women taking oral or transdermal estrogen replacement do not need additional vaginal estrogens.

A non prescription dietary supplement (a standardized extract) of Black Cohash (Cimicifuga Racemosa) helps reduce vaginal dryness for many postmenopausal women. The Black Cohash, in capsule form is taken by mouth. Over the counter vaginal moisturizers also help maintain menopause and post menopause vaginal moisture and suppleness. Over the counter creams last one to three days.

Urogenital atrophy is a medical condition that tends to occur with low estrogen. It is a consistant and inevitable consequence of menopause as the ovaries stop producing estrogen. Its symptoms can impact a woman's physical and psycho-social health. However, while other symptoms of menopause tend to lessen over time, symptoms of urogenital atrophy tend to increase over time.

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Estrogen Replacement provides benefit for the symptoms
of urinary urgency, frequency, and urge incontinence.

This effect is thought to result from reversal of urogenital atrophy
due to replacement of estrogen rather than a direct action on
the lower urinary tract.

Source:
The Role of Estrogens in Female Lower Urinary Tract Dysfunction.
Robinson D, Cardozo LD.
Department of Urogynaecology, King's College Hospital, London,

Urology. 2003 Oct;62:45

    
Increase Susceptibility to

Urinary Tract Infection (UTI)

Post menopausal women have fewer glycogen-rich vaginal cells
and therefore fewer lactobacilli present.
The vaginal pH rises to higher than 5, allowing colonization by
more pathogenic bacteria.  The distance from the urethral opening to

the vagina is reduced secondary to decreased collagen content and tissue atrophy.

This and changes in vaginal flora increase susceptibility to UTI.

Source:
Effective topical treatments for atrophic vaginitis
Nothnagle M, Taylor JS.
Int J Gynaecol Obstet. 2005;88(2):222-228.