The impact of genitourinary syndrome of menopause on continence

Most women approaching the menopause are only too aware of the possibility that they can look forward to mood swings, hot flushes, night sweats and reduced libido (Sassarini and Lumsden, 2015). What is not always so commonly appreciated is the effect of the hormonal changes on the woman's urogenital tract.

Oestrogen receptors are found in abundance in the urethra and urinary bladder, vagina and structures of the pelvic floor (Alperin et al, 2019). As the woman's oestrogen levels decline, the epithelial cells of the vagina also degenerate, with the loss of elastin, collagen and subcutaneous fat, all of which affect the integrity and robustness of the vulvovaginal tissues. Objectively, the woman may experience dryness, irritation and skin tightness in and around the vagina. In years gone by this phenomenon was known as ‘atrophic vaginitis’. The term described the external physiological signs of oestrogen deficit, but failed to effectively articulate the full spectrum of genitourinary symptoms that evidence now shows are concomitant with menopause.