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International Urogynecology Journal
Published in: International Urogynecology Journal 8/2020

Open Access 01-08-2020 | Overactive Bladder | Clinical Opinion

Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion

Authors: Barbara Bodner-Adler, May Alarab, Alejandra M. Ruiz-Zapata, Pallavi Latthe

Published in: International Urogynecology Journal | Issue 8/2020

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Abstract

Introduction and hypothesis

There is clear evidence of the presence of estradiol receptors (ERs) in the female lower urinary and genital tract. Furthermore, it is a fact that estrogen deficiency after menopause may cause atrophic changes of the urogenital tract as well as various urinary symptoms. Moreover, the effect of hormone replacement therapy (HRT) on urinary incontinence (UI) symptoms as well as pelvic organ prolapse (POP), anal incontinence (AI) and vulvovaginal symptoms (VVS) is still a matter of debate. This committee opinion paper summarizes the best evidence on influence of sex steroids as well as hormonal treatment (local and systemic) in postmenopausal women with pelvic floor disorders.

Methods

A working subcommittee from the International Urogynecology Association (IUGA) Research and Development Committee was formed. A thorough literature search was conducted and an opinion statement expressed. The literature regarding hormones and pelvic floor disorders was reviewed independently and summarized by the individual members of the sub-committee.

Results

The majority of studies reported that vaginal estrogen treatment when compared with placebo has more beneficial effects on symptoms and signs of vaginal atrophy including sensation of burning, dyspareunia and UI symptoms. Definitive evidence on local estrogen application and prolapse treatment or prevention is lacking. A statistically significant increase in risk of worsening of UI as well as development of de novo incontinence was observed with estrogen-only or combination systemic HRT.

Conclusions

In summary, local estrogen seems to be safe and effective in the treatment of VVS and can also improve urinary symptoms in postmenopausal patients with UI, but most of these recommendations correspond to evidence level 2C. The evidence in POP is still scarce but not in favor of benefit. Finally, the duration of local estrogen treatment (LET), optimal dosage, long-term effects and cost-effectiveness compared with current practice are still unknown.
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Metadata
Title
Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion
Authors
Barbara Bodner-Adler
May Alarab
Alejandra M. Ruiz-Zapata
Pallavi Latthe
Publication date
01-08-2020
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 8/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-019-04070-0

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