A study on urogenital complaints of postmenopausal women aged 50 and over

Risk Factors of Urogenital Problems among Perimenopausal Women

Introduction Menopause is a natural event that results from cessation of the menstrual cycle. It usually occurs in midlife, marking the end of women’s reproductive life. Perimenopause refers to the time at which our body makes the natural transition to the menopause and may last for 4 to 8 years. A lot of urogenital problems start appearing after the age of 40 in women. The aim of the study is to identify the risk factors of the urogenital problems in perimenopausal women.

Materials and Methods An explorative survey design with a purposive sampling method was used to collect the data from 200 women and older than 40 years admitted to the tertiary care hospital and a community under Natekal Primary Health Center were selected for the study.

Results A total of 200 women were enrolled; 85 (42.5%) had urinary tract infections, 49 (24.5%) had urinary retention, 35 (17.5%) had vaginal dryness, 17 (8.5%) had urinary incontinence, 14 (7%) had a loss of libido. The majority, 76 (38%), had this problem for 1 to 2 years. There was association between selected demographic variables with risk factors like occupation (0.023; p < 0.05), number of children (0.023; p < 0.05), and mode of delivery (0.023; p < 0.05).

Conclusion The study result concludes that there was a significant association between urogenital problems and risk factors.

Sexual function and Dyadic adjustment in women with urinary incontinence

OBJECTIVE

This study was planned to evaluate the effects of urinary incontinence (UI) on sexual function (SF) and dyadic adjustment.

METHODS

The study was conducted with 203 women with urinary incontinence. This study was conducted at Urogynecology Outpatient Clinic of our hospital between September 2017 and February 2018. Data were collected using the Dyadic Adjustment Scale (DAS), and "Female Sexual Function Index (FSFI).

RESULTS

The incidence of sexual dysfunction (SD) was higher in the patients who were in advanced age, had a husband older than them, entered menopause, had lower levels of education, had the higher frequency of UI and changed pads more frequently, and these patients had lower DAS scores.

CONCLUSION

It was determined that the majority of the participating women with UI experienced SD and that those with SD had lower DAS scores.

Study on Prevalence and Severity of Urogenital Complaints in Postmenopausal Women at a Tertiary Care Hospital

Objective:

The objective of this study was (1) to find the prevalence of urogenital (UG) complaints after menopause, (2) to evaluate the various risk factors for UG problems in postmenopausal women, and (3) to assess the severity of the symptoms depending on the duration of menopause.

Materials and Methods:

This study is a prospective study conducted at the Specialty Outpatient Department in Safdarjung Hospital over a period of 1 year. Two hundred postmenopausal women during this period were screened for UG complaints by eliciting detailed history in a pro forma and were divided into two groups based on the duration of menopause. Women with preexisting complaints before menopause and those with some medical disorders such as diabetes, stroke, or neurological problems were excluded from the study. Data were analyzed by standard statistical analytical tests.

Results:

The prevalence of UG symptoms in our study was 67%. Group A constitutes 127 (63.5%) participants in which menopause attained was of 1–5-year duration. Group B comprises the women with >5-year duration of menopause and it includes 73 (36.5%) patients. Among the genital complaints, vaginal dryness was the most common complaint in both the groups (Group A: 62% and Group B: 48%) followed by vaginal discharge or infection (Group A: 28% and Group B: 25%). Around 19 (15%) in Group A and 10 (13.6%) in Group B were having burning micturition (dysuria), the most common complaint encountered. The UG complaints were not statistically significantly different in both the groups. The severity of the symptoms was significantly different in two groups with more severe complaints in Group A as compared to Group B.

Conclusion:

UG complaints associated with estrogen loss can occur episodically throughout a women's life, but it is most common and chronic in the duration in postmenopausal women.

Behavioral and Psychosocial Risk Factors Associated with First and Recurrent Cystitis in Indian Women: A Case-control Study

Background:

The risk factors for urinary tract infections (UTIs) from developed countries are not applicable to women from developing world.

Objective:

To analyze the behavioral practices and psychosocial aspects pertinent to women in our region and assess their association with acute first time or recurrent UTI.

Materials and Methods:

Sexually active premenopausal women with their first (145) and recurrent (77) cystitis with Escherichia coli as cases and women with no prior history of UTI as healthy controls (257) were enrolled at a tertiary care hospital in India, between June 2011 and February 2013. Questionnaire-based data was collected from each participant through a structured face-to-face interview.

Results:

Using univariate and multivariate regression models, independent risk factors for the first episode of cystitis when compared with healthy controls were (presented in odds ratios [ORs] with its 95% confidence interval [CI]): Anal sex (OR = 3.68, 95% CI = 1.59-8.52), time interval between last sexual intercourse and current episode of UTI was <5 days (OR = 2.27, 95% CI = 1.22-4.23), use of cloth during menstrual cycle (OR = 2.36, 95% CI = 1.31-4.26), >250 ml of tea consumption per day (OR = 4.73, 95% CI = 2.67-8.38), presence of vaginal infection (OR = 3.23, 95% CI = 1.85-5.62) and wiping back to front (OR = 2.52, 95% CI = 1.45-4.38). Along with the latter three, history of UTI in a first-degree female relative (OR = 10.88, 95% CI = 2.41-49.07), constipation (OR = 4.85, 95% CI = 1.97-11.92) and stress incontinence (OR = 2.45, 95% CI = 1.18-5.06) were additional independent risk factors for recurrent cystitis in comparison to healthy controls.

Conclusion:

Most of the risk factors for initial infection are potentially modifiable but sufficient to also pose risk for recurrence. Many of the findings reflect the cultural and ethnic practices in our country.

Prevalence of urinary incontinence in older Turkish women, risk factors, and effect on activities of daily living

PURPOSE

The study was conducted to determine the prevalence of urinary incontinence (UI) among older women, risk factors, and the effect on activities of daily living (ADLs).

METHOD

The study was conducted in family health centers located in a city in eastern Turkey. The study population consisted of 1094 women age 65 and older chosen with a simple random sampling method. The inclusion criteria were 65 years and older, female, and not diagnosed with mental or emotional diseases or conditions that obstruct communication. Data were collected in face-to-face interviews with the Questionnaire and Daily Life Activities Data Form created by the researchers based on the Roper, Logan, and Tierney model.

RESULTS

The prevalence of UI in women age 65 and older was 51.6%, and the most common type was urge incontinence. The number of births, number of abortions, age at last birth, and home births affected the development of UI (p<0.001). In addition, body mass index, constipation, urinary tract infection, cough, hormone replacement therapy, genital prolapse, cystocele, urogenital surgery, nocturia, and daily urine output were determined to be risk factors (p<0.001). Among the ADLs, 13.7% with UI reported that they had fallen when getting up from the toilet, 34.3% had experienced a sense of shame, 45.8% avoided coughing, and 46.5% restricted fluid intake.

CONCLUSION

Prevalence of UI in women age 65 and older was high, and the most common was urge incontinence. UI has many risk factors and affects many ADLs.

Vaginal oestrogen for overactive bladder in post-menopausal women

This article asks the question 'Should nurses recommend vaginal oestrogen for overactive bladder in post-menopausal women?' The article will review the evidence for use of vaginal oestrogen and consider the potential side-effects and risks. The main finding is that vaginal oestrogen is effective for treatment of overactive bladder in post-menopausal women with vaginal atrophy. However, vaginal atrophy is undertreated. This article identifies some of the barriers that may prevent diagnosis and treatment, and suggests changes in practice. Nurses should take the initiative and ask post-menopausal women about symptoms. Nurses should be trained to examine women, diagnose vaginal atrophy and discuss treatment.

Stress urinary incontinence animal models as a tool to study cell-based regenerative therapies targeting the urethral sphincter

Urinary incontinence (UI) is a major health problem causing a significant social and economic impact affecting more than 200million people (women and men) worldwide. Over the past few years researchers have been investigating cell therapy as a promising approach for the treatment of stress urinary incontinence (SUI) since such an approach may improve the function of a weakened sphincter. Currently, a diverse collection of SUI animal models is available. We describe the features of the different models of SUI/urethral dysfunction and the pros and cons of these animal models in regard to cell therapy applications. We also discuss different cell therapy approaches and cell types tested in preclinical animal models. Finally, we propose new research approaches and perspectives to ensure the use of cellular therapy becomes a real treatment option for SUI.

Expression of the estrogen receptors and steroidogenic enzymes involved in estradiol formation in the monkey vagina

OBJECTIVE

Estrogens are well recognized to have beneficial effects on vulvovaginal atrophy because of menopause. The distribution of estrogen receptors and enzymes responsible for estradiol (E2) formation within the vagina may provide insight into how dehydroepiandrosterone, a precursor of both estrogens and androgens, improves vulvovaginal atrophy.

STUDY DESIGN

The purpose of the study was to determine where the steroidogenic enzymes responsible for E2 formation as well as estrogen receptors are localized in vaginal specimens collected from cynomolgus monkeys (Macaca fascicularis), the closest model to the human. HSD3B1, HSD17B1, HSD17B5, HSD17B12, aromatase (CYP19A1), estrogen receptor (ER)-α, and ER-β were measured or localized by quantitative real-time polymerase chain reaction, immunohistochemistry, and immunofluorescence. Estrogens were quantified by liquid chromatography/tandem mass spectrometry.

RESULTS

All steroidogenic enzymes and estrogen receptors are localized mainly in the superficial layer of the stratified squamous epithelium, blood vessel walls, and muscle fibers of the vagina. Immunolabeling of HSD17B5 and HSD17B12 shows that these enzymes are uniformly distributed from the basal membrane to the superficial keratinized cells, whereas HSD3B1 and aromatase are particularly localized in the outer (external) portion of the epithelial layer. ER-α and ER-β are also distributed within the vaginal epithelium, with expression especially elevated at the basal membrane level.

CONCLUSION

The enzymes responsible for E2 formation as well as ERs are expressed mainly in the superficial layer of the stratified epithelium as well as the muscle layer of the vagina. The present data provide morphologic and biochemical support for the role of local dehydroepiandrosterone transformation into estrogens in regulating epithelial cell maturation, pH, fluid secretion, smooth muscle activity, and blood flow regulation in the primate vagina.

The impact of cesarean delivery on pelvic floor dysfunction in lysyl oxidase like-1 knockout mice

OBJECTIVE

: Lysyl oxidase like-1 (LOXL1) knockout mice have abnormal elastic fiber homeostasis and frequently develop pelvic floor dysfunction after pregnancy and delivery. The objective of this study was to test the hypothesis that tissue changes associated with vaginal delivery lead to pelvic floor dysfunction as a result of abnormal elastic fiber homeostasis.

METHODS

: Female LOXL1 knockout mice delivered either spontaneously or by cesarean delivery. Mice were assessed weekly for pelvic organ prolapse (POP). At 12 weeks postpartum, lower urinary tract function was assessed by cystometry and leak-point pressure testing. Urethrovaginal cross-sections were analyzed using a histologic grading scale to assess elastin fiber disorganization.

RESULTS

: A total of 39 mice delivered by spontaneous vaginal delivery and 36 by cesarean delivery. Twelve weeks after spontaneous vaginal delivery or cesarean delivery, 23 (59%) and 11 (31%) mice had developed POP, respectively. The mean time to develop POP was 7.2 weeks after spontaneous vaginal delivery and 10.5 weeks after cesarean delivery (log rank, P = 0.0008). The Cox proportional hazard ratio was 0.55 (95% confidence interval, 0.38-0.79). Mice with POP had increased frequency of bladder contractions not associated with voiding during cystometry (P = 0.02). POP, but not mode of delivery, was associated with increased elastic fiber disorganization.

CONCLUSIONS

: Cesarean delivery delays the development of POP in LOXL1 knockout mice. POP is associated with increased bladder contraction frequency and increased elastic fiber disorganization in the urethra and vagina. The mechanisms underlying these findings warrant further investigation.

Prevalence, incidence and obstetric factors' impact on female urinary incontinence in Europe: a systematic review

OBJECTIVES

A systematic review of the published data on the prevalence, incidence and risk factors of female urinary incontinence (UI) and obstetric treatment of UI in Europe.

DATA SOURCES

Epidemiologic studies were sought via PubMed to identify articles published in English, French, Spanish, German and Italian between 2000 and September 30, 2010, in Europe.

RESULTS

The prevalence of UI ranged from 14.1 to 68.8% and increased with increasing age. Significant risk factors for UI in pregnancy were maternal age ≥35 years and initial body mass index, a family history of UI and parity. UI in women who delivered 'at term' ranged from 26 to 40.2%, with a remission rate of 3 months after childbirth of up to 86.4%. Pelvic floor muscle training may help to prevent postpartum UI in primiparous women without UI during pregnancy.

CONCLUSION

UI definition, outcome measures, survey methods and validation criteria are still heterogeneous, and thus it is difficult to compare data and impossible to draw definite conclusions.

Sexual function of women with premature ovarian failure

OBJECTIVE

The aim of this study was to evaluate the sexual function of women with premature ovarian failure (POF).

METHODS

A cross-sectional study was performed to evaluate 58 women with a diagnosis of POF compared with a control group composed of 58 women of reproductive age with normal ovarian function, paired for age (±2 y). Sexual function was evaluated in the two groups using the Female Sexual Function Index (FSFI).

RESULTS

The mean ± SD age of the women in the POF and control groups was 39.4 ± 6.5 and 39.0 ± 6.8 years, respectively. Mean ± SD FSFI score was 24.0 ± 6.0 and 27.3 ± 4.8 in the POF and control groups, respectively. The prevalence of sexual dysfunction (total FSFI score ≤ 26.55) in the POF group was 62.1% (n = 36) compared with 37.8% (n = 22) in the control group (P = 0.0093). In the analysis of domains, the only domain in which no statistically significant difference was found between the two groups was desire. For the domains of arousal, lubrication, orgasm, satisfaction, and pain, scores were significantly lower, hence poorer, in the group of women with POF compared with the control group. Belonging to the POF group increased a woman's likelihood of having sexual dysfunction by 2.8-fold (OR = 2.78, IC 1.29 to 5.98, P < 0.05).

CONCLUSIONS

Women with POF had a higher prevalence of sexual dysfunction compared with women with normal gonadal function and more difficulties in relation to satisfaction, lubrication, orgasm, pain, and arousal; however, there were no differences between the two groups with respect to desire.

Vaginal estrogens for the treatment of dyspareunia

INTRODUCTION

Vaginal atrophy, which is associated with vaginal itching, burning, dryness, irritation, and pain, is estimated to affect up to 40% of postmenopausal women. Estrogens play a key role in maintaining vaginal health; women with low serum estradiol are more likely to experience vaginal dryness, dyspareunia, and reduced sexual activity compared with women who have higher estradiol levels.

AIMS

The purpose of this review is to assess the prevalence and impact of dyspareunia, a symptom of vaginal atrophy, on the health of postmenopausal women and to evaluate treatment options using vaginal estrogens (U.S. Food and Drug Administration [FDA] approved).

METHODS

Relevant published literature was identified by searching Index Medicus using the PubMed online database. The search terms dyspareunia, vaginal estrogen, vaginal hormone therapy, vaginal atrophy, and atrophic vaginitis were the focus of the literature review.

RESULTS

Current treatment guidelines for vaginal atrophy recommend the use of minimally absorbed local vaginal estrogens, along with non-hormonal lubricants or moisturizers, coupled with maintenance of sexual activity. Vaginal estrogen therapy has been shown to provide improvement in the signs and symptoms of vaginal or vulvar atrophy. Vaginal tablets, rings, and creams are indicated for the treatment of vaginal atrophy, and the FDA has recently approved a low-dose regimen of conjugated estrogens cream to treat moderate-to-severe postmenopausal dyspareunia. The use of low-dose vaginal estrogens has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining, and no significant differences have been seen among vaginal preparations in terms of endometrial safety.

CONCLUSION

Women should be informed of the potential benefits and risks of the treatment options available, and with the help of their healthcare provider, choose an intervention that is most suitable to their individual needs and circumstances.

Identification and structure-activity relationships of chromene-derived selective estrogen receptor modulators for treatment of postmenopausal symptoms

As part of a program aimed at the development of selective estrogen receptor modulators (SERMs), novel chromene scaffolds, benzopyranobenzoxapanes, were discovered. Many compounds showed binding affinity as low as 1.6-200 nM, displayed antagonist behaviors in the MCF-7 human breast adenocarcinoma cell line as well in Ishikawa cell line with IC(50) values in the range 0.2-360 nM. On the basis of the side chain substitution, various compounds demonstrated strong inhibitory activity in anti-uterotropic assay. Compound 7-(R) and its major metabolites 5-(R) and 6-(R) were evaluated in several in vivo models of estrogen action. Relative to a full estrogen agonist (ethynyl estradiol) and the SERM raloxifene, 7-(R) was found to be a potent SERM that behaved as antagonist in the uterus and exhibited estrogen agonistic activity on bone, plasma lipids, hot flush, and vagina. The overall pharmacokinetic profile and stability were significantly improved compared to those of the phase 2 development compound 9-(R).

Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial

OBJECTIVE

To compare vaginal repair augmented by mesh with traditional colporrhaphy for the treatment of pelvic organ prolapse.

DESIGN

Prospective randomised controlled trial.

SETTING

Tertiary teaching hospital.

POPULATION

One hundred and thirty-nine women with stage >or=2 prolapse according to the pelvic organ prolapse quantification (POP-Q) system requiring both anterior and posterior compartment repair.

METHODS

Subjects were randomised to anterior and posterior vaginal repair with mesh augmentation (mesh group, n = 69) or traditional anterior and posterior colporrhaphy (no mesh group, n = 70).

MAIN OUTCOME MEASURES

The primary outcome was the absence of POP-Q stage >or=2 prolapse at 12 months. Secondary outcomes were symptoms, quality-of-life outcomes and satisfaction with surgery. Complications were also reported.

RESULTS

For subjects attending the 12-month review, success in the mesh group was 81.0% (51 of 63 subjects) compared with 65.6% (40/61) in the no mesh group and was not significantly different (P-value = 0.07). A high level of satisfaction with surgery and improvements in symptoms and quality-of-life data were observed at 12 months compared to baseline in both groups, but there was no significant difference in these outcomes between the two groups. Vaginal mesh exposure occurred in four women in the mesh group (5.6%). De novo dyspareunia was reported by five of 30 (16.7%) sexually active women in the mesh group and five of 33 (15.2%) in the no mesh group at 12 months.

CONCLUSION

In this study, vaginal surgery augmented by mesh did not result in significantly less recurrent prolapse than traditional colporrhaphy 12 months following surgery.

Dyspareunia in postmenopausal women: a critical review

BACKGROUND

Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.

OBJECTIVES

To critically review the literature on the prevalence, risk factors, etiology, clinical presentation and treatment of postmenopausal dyspareunia. The present review also examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a direct symptom of hormonal decline.

METHODS

Searches of medical and psychological databases were performed for relevant articles and empirical studies. The methodological quality and outcomes of the studies were systematically reviewed.

RESULTS

Available empirical evidence suggests that dyspareunia is common in postmenopausal women, and that it is not highly correlated with menopausal status, estrogen levels or vaginal atrophy. Decreasing levels of endogenous estrogen contribute to the development of dyspareunia in postmenopausal women suffering from vaginal atrophy. Hormonal supplementation is beneficial in alleviating their pain. However, a substantial proportion of treated women do not report relief.

CONCLUSIONS

Postmenopausal dyspareunia occurring concurrently with vaginal atrophy is strongly associated with a lack of estrogen in the genital tract. However, a significant percentage of postmenopausal women experience dyspareunic pain that is not caused by hypoestrogenism. It is likely that other types of dyspareunia that occur premenopausally are also occurring in postmenopausal women. Research is needed to adequately address this issue. A change in perspective toward a multiaxial pain-focused approach is proposed for future research concerning dyspareunia in postmenopausal women.

Urogenital atrophy

The British Menopause Society Council aims to aid health professionals to inform and advise women about postreproductive health. This guidance refers to the long-term condition of urogenital atrophy. Treatment choice should be based on up to date information and targeted to individual women's needs. Non-estrogen and estrogen-based treatments are discussed.

Urogenital symptoms of postmenopausal women in Turkey

OBJECTIVE

The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey.

DESIGN

The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice.

RESULTS

The mean age of participants was 58.64 +/- 8.14 years. The mean age of menopause was 47.21 +/- 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency.

CONCLUSIONS

Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.

Incidence of stress urinary incontinence among women in Turkey

The aim of this study was to determine the incidence of stress urinary incontinence among women at the age of 15 and above who applied to the primary health care centers in Ankara, Turkey. We applied the urinary stress incontinence questionnaire to 2,601 women at the age of 15 or above who consulted to the "mother-child health care and family planning centers" in January 2002. To evaluate the urinary incontinence status with respect to age groups and other risk factors, chi-square test was used. Stress incontinence prevalence was 16.1% in our population. Age was a statistically significant risk factor affecting the incidence of stress incontinence. As the number of gravida increases, the frequency of stress incontinence increases (p<0.05). Presence of a systemic disease was also an important risk factor (p<0.05). Alcohol use and smoking were not found to affect the incidence of urinary stress incontinence (p>0.05). As urinary incontinence greatly influences life quality and social and psychological status of the person, and also creates economic burden, predisposing factors of stress incontinence should be well defined and measures should be taken to encourage women experiencing this problem to visit a doctor and to get an efficient treatment.

Abdominal sacral colpopexy: an independent prospective long-term follow-up study

AIMS

The aim of the study was to provide a long-term follow up of subjective and objective outcomes following sacral colpopexy.

METHODS

A cohort of 148 women who had undergone sacral colpopexy in a tertiary unit between 1998 and 2001 were contacted for follow-up. Women were questioned about current symptoms including patient determined subjective measures and the Baden-Walker site specific examination for vaginal prolapse was performed.

RESULTS

Ninety-three women were able to be contacted for review. Of these, 64 were available for clinical examination and a further 29 were available for telephone interview. Of those women examined 62 had good vault support. Therefore, recurrent vault prolapse was uncommon at 3%. Recurrent prolapse was present in other vaginal compartments in 40.6% of women. Subjectively 78% of women felt that their prolapse symptoms had resolved and 65% had a visual analogue score (VAS) >or= 80, indicating satisfaction with the surgery. Stress urinary incontinence symptoms decreased at this long-term review, however, 24% of women required further incontinence surgery.

CONCLUSIONS

Abdominal sacral colpopexy is an effective technique for the management of vaginal vault prolapse, with a two-year successful outcome in excess of 90%. Further study is required to investigate recurrent prolapse in other vaginal compartments and the functional aspects following surgery.