Hormonal Influences on the Pelvic Floor

Reproductive hormones, especially estrogen, have a significant impact on pelvic floor function. Hormonal changes that occur during a woman's lifespan impact many aspects of female physiology.With the onset of menopause, it becomes evident that estrogen sensitivity is greatest in the central nervous system and the genital tissues.The most frequently occurring initial symptoms of estrogen deprivation include hot flushes,mood changes, and emotional irritability. These central nervous system symptoms are promptly reversible with systemic estrogen replacement. More prolonged duration of estrogen deprivation will lead to other known consequences such as osteoporosis and urogenital atrophy. It is estimated that 80% of postmenopausal women have hot flushes, and that not all women will develop osteoporosis. However, urogenital atrophy occurs universally. Interestingly, many women with urogenital atrophy are asymptomatic. Many treatments are currently available for prevention of and therapy for loss of bone mineral content. However, local estrogen therapy is the only means of treating symptoms and signs of urogenital atrophy.

As related to the pelvic floor, urogenital atrophy is present at both ends of the reproductive cycle, and consequences such as labial fusion may be present both preme-narchally as well as postmenopausally. After the onset of menopause, hypoestrogenism is expressed in the lower genitourinary tract by thinning of the vaginal and urethral mucosa, as well as other well-recognized changes (Table 11-1.1). Estrogen receptors have been found in most body tissues. The presence of estrogen receptors in the pelvic floor mucosa has been demonstrated, as has the importance of the estrogen-replete state in physiologic cellular proliferation. The implications of the lack of estrogen on urogenital well-being will be discussed in this chapter.