UROGENITAL AGING - A HIDDEN PROBLEM

Urogenital problems in the elderly female population are experienced b y one third of women from the age 50 years and onward. Symptoms from t he lower urinary tract include incontinence, urethritis, and recurrent urinary tract infections. Atrophic changes within the bladder neck an d urethra could be corrected by estrogen administration even at doses so low that endometrial proliferation is avoided. Hence such estrogens could be given without progestogen comedication. Control of micturiti on is a complex process of which estrogen deficiency is only one of se veral factors. The aging process with subsequent changes in membrane p ermeability, neuromuscular function, and collagen synthesis contribute s to the local problems of control of micturition. In addition, the ce ntral control may also be affected by degenerative changes of the nerv ous system. Vaginal symptoms comprise dryness of vagina, dyspareunia, and recurrent vaginitis often followed by a fowl odor and discharge. T he microflora with lactobacilli and low pH as seen in fertile women is gradually replaced by a mixed germ flora including several of the pat hogenic organisms common in urinary tract infections. Vaginal pH incre ases from around 4 to between 6 and 7. It is a puzzling fact that the urogenital tissues seem to be more ''sensitive'' to estrogens than oth er tissues. Conformational changes of the estrogen receptor(s) brought about by the local cytokine milieu is one possibility to explain the situation. The systemic absorption of low-dose estrogen preparations i s dependent on the status of the vaginal mucosa. Absorption is high wh en the vaginal mucosa is atrophic and gradually decreases (but not:to zero) as the vaginal mucosa matures under estrogen influence.