|
|
This Open Access site was originated September 2006 Updated December 2008
with compassion | | | Sharing advancements in women’s health . . . and enhancing women’s knowledge of menstrual physiology, the menopausal transition and post-menopausal health. | | | Welcome Site Map very helpful Why Donate Contact Info | | |
An Important Point to help understand symptoms  of vaginal dryness and such . . . | During the menopausal transition, estradiol levels drop from 120 ng/L to about 18 ng/L.
The vaginal canal shrinks in length and diameter and blood flow to the vagina decreases. For many, many women such changes cause symptoms & discomfort. | | |
| | Understanding Vaginal and Bladder Changes
During the Menopausal Transition |
| | After menopause, estrogen (estradiol) production drops significantly.Vaginal tissue is highly estrogen sensitive. During the reproductive years, estrogen matures the vaginal tissue, making it thicker and rugated. During menopause and postmenopause diminished estrogen results in thinning of the vaginal and vulvar tissue (epithelium). The vulva and vagina become more pale in color, drier and more easily injured or irritated by sexual activity.
The base of the bladder also has estrogen sensitive tissue. Menopausal epithelial changes in the bladder also result in thin, pale, fragile tissue.
These vaginal and bladder changes are referred to as Uro-genital Atrophy. Symptoms are usually mild during the menopause transition, and tend to become more progressive during the postmenopausal years.
Symptoms of Atrophic Vaginitis can present as vaginal dryness, vulvovaginal pruritus (itch), vaginal dyspareunia (painful intercourse) & postcoital spotting.
Symptoms of Atropic Urethritis and recurrent cystitis (inflammation of the urinary bladder) can present as dysuria (difficult or painful urination), frequency and incontinence (inability to control urination).
Source: Menopause Susan D. Reed MD., MPH and Elica L.Sutton, MD Clinical Review ACP Medicine October 2004 ISSN:1547-1659 | |
Options to Reduce Symptoms of Vaginal and Uro-genital Discomfort 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 postmenopausal women.
Vaginal estrogen cream, a vaginal estrogen tablet (25 mcg) 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. Vaginal 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 ring, systemic estradiol levels do not rise above postmenopausal levels (20-30 pmol/L), making endometrial proliferation less likely. Several studies have established that a level greater than 60 pmol/L must be maintained to precipitate 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.
Over the counter vaginal moisturizers also help maintain menopausal and post menopausal vaginal moisture and suppleness. 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.
Urinary Urgency, Frequency, and Urge Incontinence. . . . for much more about bladder weakness click here Estrogen Replacement may be of 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 such as streptococci, staphylococci, coliforms, and diphtheroids. The distance from the urethral opening to the vaginal introitus 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.
| | | | | |
| | Menopausal and Post-menopausal
Vaginal pH changes contribute to symptoms | | | A healthy vaginal flora reduces the risk of urogenital infections.An important function of the vaginal and cervical epithelial cells is to regulate the pH of the lumen of the lower genital tract. During the pre-menopausal years vaginal luminal pH ranges between 4.5 and 6.0 with mild alkalinization to about 6.5 before ovulation.
Lack of estrogen, such as after menopause, is associated with alkalinization to about 6.5 - 7.0. Alkalinization above 6.5 is associated with increased risk of vaginal infections, whereas low (acidic) vaginal pH can inhibit the growth of serious pathogens. Alkalinization of the vaginal fluid can also cause dyspareunia: painful intercourse.
The normal vagina of an adult woman is colonised by lactobacilli. These probiotic bacteria produce lactic acid, which maintains an acidic pH and hydrogen peroxide, which acts as an antiseptic agent. Lactobacilli protect the vagina from pathogenic infections and are considered important for vaginal health. Lactobacillus species help acidify vaginal luminal pH which reduces the risk of urogenital infections.
The production of hydrogen peroxide by lactobacillus species is thought to represent a nonspecific antimicrobial defense mechanism of the normal vaginal ecosystem.
On a deeper level: The origin of the uropathogens in uncomplicated urinary tract infections (UTI) and bacterial vaginosis is the fecal flora. The key factor in pathogenesis has been regarded as the ability of the pathogens to attach to epithelial cells, thereby allowing them a niche in which to establish, multiply, spread, and avoid host defenses. Numerous studies have investigated and documented the adhesins and receptor sites involved in the attachment process. Factors such as hemolysins, aerobactin, capsular antigens, and others play a role in E. coli pathogenesis in UTI. Furthermore, there are host susceptibility factors, including genetic determinants, age-related changes, and mucosal differences that influence the infection process.
Sources: Probiotic agents to protect the urogenital tract against infection. Gregor Reid American Journal of Clinical Nutrition, Vol. 73, No. 2, 437S-443s, February 2001
Estrogen Acidifies Vaginal pH by Up-Regulation of Proton Secretion via the Apical Membrane of Vaginal- Ectocervical Epithelial Cells. George I. Gorodeski, Ulrich Hopfer MDs Endocrinology Vol, No. 2 816-824
The role of estrogens in female lower urinary tract dysfunction. Robinson, D., & Cardozo, L. MDs Urology, 62 (4A Suppl.), 45-51 2003. Effective Topical Treatments for Atrophic Vaginitis Nothnagle M, Taylor JS. Int J Gynaecol Obstet. 2005;88(2):222-228. | |
“Ownership and Rights. Vascular Events (a nonprofit organization), Inc., shall own all and exclusive right, title, and interest in the work throughout the world, including copyrights, domain names, trademarks, and all other intellectual property rights in the work. The work shall be deemed to be a work-for-hire under the Copyright Act of 1976, Title 17 U.S.Code, and Vascular Events Inc., shall be deemed to be the author.” | | | | Information is provided for educational purposes to help individuals form an understanding of biological processes as they effect health. This information is not intended for medical diagnosis or treatment. | | | |
|
|
|