Bladder Dysfunction and Urinary Incontinence After the Menopause: Hormones, Drugs, or Surgery?

Abstract

The female pelvic floor undergoes a large number of adaptive changes, related to life and endocrine events. Most of the clinical manifestations of these changes become evident after menopause. The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs, associated with changes of the vulva, vagina, and lower urinary tract, such as dyspareunia, dysuria, frequency, nocturia, incontinence, and recurrent infections. Given the connection between menopause and aging bladder dysfunction, the physicians who manage these complex patients should be urologists and endocrinologists. There are several options for the menopause genitourinary syndrome treatment. Lifestyle changes and bladder retraining are recommended as first line therapy for overactive bladder symptoms. Drug therapy options, including antimuscarinic medications and beta-3 adrenergic receptor agonists, combined with local estrogens, constitute medical treatment in postmenopausal women with overactive bladder. Local estrogens therapy effectively relieves vulvovaginal symptoms and is effective for the treatment of urge urinary incontinence, overactive bladder, and recurrent urinary tract infections (UTIs). Intravesical botulinum toxin appears to be an effective therapy for refractory OAB symptoms. The electrical stimulation, combined with other therapies for increasing the maximum bladder capacity, is another good option in patients with refractory OAB symptoms. All women complaining about stress urinary incontinence will benefit from pelvic floor muscle training in the first instance. It seems that there are no beneficial effects in using estrogens therapy, both local and systemic, on stress urinary incontinence. Anyway some of them will ultimately undergo surgery, retropubic and transobturator tapes. Currently, the most popular procedures are sling operations both traditional and minimally invasive synthetic suburethral.