Women during the end of the menstrual cycle undergo a rapid change in the ratio of hormones present in their bodies, leading to various urogenital changes. Hormones such as estrogen play a crucial role in maintaining the health of urogenital tissues like the bladder, urethra, and vaginal walls.
A decrease in estrogen levels can give rise to symptoms such as vaginal dryness, atrophy, and reduced elasticity, contributing to discomfort and potential complications. Understanding the causes of these urogenital changes can help provide unique care for women during the end of the menstrual cycle.
The main reasons for the cause of symptoms and changes in the women are as follows:
“One is the decreasing estrogen levels in the body as a woman goes through menopause which is defined as when she stops having periods for 12 months in a row. The eggs in the ovary are depleted over her reproductive life span and menopause signals the time when there are either no eggs or too few eggs left in the ovary.”
This means that the hormones which are normally produced as part of the process of ovulation are not produced. The most important hormone is estrogen, although several other hormones are also affected e.g., progesterone, testosterone, DHEA, oxytocin, cortisol.
The second reason is the progressive changes that happen with ageing and illnesses that become common with ageing. These are obesity, hypertension, diabetes mellitus, effects of pregnancy and delivery and the effect of several medications that a woman might be taking (diuretics and sedatives). Surgery such as a hysterectomy can also aggravate these changes.
Risks of incontinence as we age
You don’t have to live with incontinence – get help
Incontinence is often described as a dreaded part of ageing and it doesn’t have to be that way.
Both urinary and fecal incontinence worsen with ageing and for many women it can start around the time of menopause. One in two adults over the age of 80 has incontinence of either bladder or bowel or both.
The measures to prevent incontinence and its problems needs to be addressed several decades before it happens. This means that we need to put in place the habits and behaviours that can prevent incontinence or reduce its impact on our quality of life even before we become menopausal.
So, if you remember how to do your pelvic floor exercises it is probably time to start doing them again now rather than wait for bladder and bowel symptoms to start.
It also means that we need to get access to and use the treatments that are available to us to do this.
Incontinence isn’t just inconvenient. It has several other health issues associated with it.
- Incontinence affects the skin of the genitals and can cause irritation and ulceration that doesn’t heal easily.
- Incontinence results in a need to wear diapers / nappies / incontinence pads that cause chaffing and skin damage especially when needed to be worn constantly.
- Some women may need to learn to catheterize themselves or need a catheter long term to manage incontinence. This results in risk of infection and bladder or kidney damage.
- Incontinence can result in leaking accidents which can aggravate falls and hip fractures – a major cause of death in women over the age of 65 years because of osteoporosis.
- Social isolation and depression – women who leak or feel uncomfortable if they are not near a toilet can isolate themselves and stop socializing. It can cause intimate relationships to break down. This worsens depression and anxiety and is another major cause of death and a suicide risk.
Conclusion:
Understanding the impact of menopause on urogenital health is crucial, emphasizing the importance of preventing and seeking help for incontinence. This approach challenges social norms, encourages open discussions about women’s health during the menstrual cycle, and breaks down the boundaries that hinder the proper care of women during this phase.
Do write to me at masterthemenopause@gmail.com about what you liked in this article and whether it helped you address some of your concerns.
Look out for more content related to topics in this article as I will be diving deeper into them in future posts.
References:
Traditional suburethral sling operations for urinary incontinence in women. Rehman H, Bezerra CCB, Bruschini H, Cody JD. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD001754. DOI: 10.1002/14651858.CD001754.pub3.
Adrenergic drugs for urinary incontinence in adults. Alhasso A, Glazener CMA, Pickard R, N’Dow JMO. Cochrane Databaseof Systematic Reviews 2005, Issue 3. Art. No.: CD001842. DOI: 10.1002/14651858.CD001842.pub2.
Oestrogen therapy for urinary incontinence in post-menopausal women. Cody JD, Richardson K, Moehrer B, Hextall A, Glazener CMA. Cochrane Database of Systematic Reviews2009, Issue 4. Art. No.: CD001405. DOI:10.1002/14651858.CD001405.pub2.
Bladder training for urinary incontinence in adults. Wallace SA, Roe B, Williams K, Palmer M. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001308. DOI: 10.1002/14651858.CD001308.pub2
Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Gabriela Kołodyńska, Maciej Zalewski, and Krystyna Rożek-Piechura. Prz Menopauzalny. 2019 Apr; 18(1): 46–50.Published online 2019 Apr 9. doi: 10.5114/pm.2019.84157. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528037/