Running Head: TOPICAL ESTROGENS IN VAGINAL ATROPHY
Topical Estrogens in Vaginal Atrophy
TOPICAL ESTROGENS IN VAGINAL ATROPHY
Vaginal atrophy is a common result of the estrogen depletion after menopause. Most menopausal symptoms tend to get better as women get through the years of menopause but vaginal atrophy seems to get worse. Vaginal atrophy seems to affect 50% of menopausal women on average. (Kelley, 2007) Symptoms of vaginal atrophy are vaginal itching, burning, pressure and irritation. Estrogen also plays a big role in the musculature of the pelvic floor and the organs involved. The external and internal genitalia are predominately affected by the hormone estrogen. Major support ligaments are the pubococcygeus muscle and the musculature of the pelvic floor. Estrogen is present in most of these muscles and ligaments. The sacral nerves in the spinal cord influence the pudendal nerves of the pelvic floor. Estrogen receptors are present in all these areas. Estrogen can directly affect detrusor function through muscarinic receptors and calcium ion movement into cells. (Kelly, 2007) Estrogen increases urethral resistance, raises the sensory threshold of the bladder, increases adrenoreceptor sensitivity in the urethral smooth muscle and promotes relaxation of the detrusor muscle. (Kelley, 2007) The main symptoms of vaginal atrophy are vaginal dryness, loss of pelvic support with resulting prolapse, decrease in the tissue elasticity with resulting dyspareunia or pressure to void frequently and urogenital discomfort. The loss of estrogen in tissues can cause a reduced urinary flow rate, increased urinary residual volume, higher filling pressures, reduced bladder capacity and lower maximal voiding pressures. (Kelley, 2007) Urethral closure and pressure is a main component of continence. Vaginal symptoms are most common and more severe in smokers, due to increased estrogen metabolism...
References: Eriksen, P. & Rasmussen. H. (1992) Low dose 17B-estradiol vaginal tablets in the treatment of vaginal atrophy: a double blind placebo controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 44, 137-144
Ewies, A. A. A. & Al-Baghdadi, O. (2009) Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up to date overview. Climacteric;12:91-105
Kelly, C. (2007) Estrogen and its effect on vaginal atrophy in post-menopausal women. Urologic Nursing. (1) 40-6
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