POSTMENOPAUSAL VAGINAL ATROPHY AND ATROPHIC VAGINITIS

Menopause is associated with a marked reduction in endogenous estrogen production, Lower levels of circulating blood estrogen have various d eleterious effects, including those on the lower urinary tract. The va ginal epithelium becomes atrophied and dry, which can cause vaginal di scomfort, itching, and dyspareunia. The epithelium may become inflamed and contribute to urinary symptoms, including frequency, urgency, dys uria, and incontinence. Diminished estrogen effects on periurethral ti ssues can contribute to pelvic laxity and stress incontinence. Changes in vaginal pH and normal flora may predispose older women to urinary tract infection. Although estrogen replacement therapy can result in m aturation of the vaginal epithelium, the optimal form of administratio n and the dosage regimen for improving symptoms and quality of life of the geriatric female population have not been well studied.