The menopause, urinary incontinence and other symptoms of the genito-urinary tract

Risk factors, urodynamic characteristics, and distress associated with nocturnal enuresis in overactive bladder -wet women

Patients with overactive bladder syndrome-wet (OAB-wet) experience urgency urinary incontinence, particularly urinary frequency and nocturia. Nocturnal enuresis (NE) is less addressed among OAB-wet patients. The study evaluated the prevalence of NE, lower urinary tract symptoms (LUTS), urodynamic factors, and social factors in OAB-wet patient. Over three years, adult women with urgency urinary incontinence were enrolled. A comprehensive questionnaire, including baseline characteristics, LUTS, fatigue, stress, and partner relationship was completed by the participants. NE was defined as complaint of intermittent incontinence that occurs during the main sleep period. Urodynamics was performed on every patient to assess bladder function. Of 203 OAB-wet patients (age: 64.45 years), 46.4% had NE. Patients with NE had higher scores of intermittency, slow stream, straining, hesitancy, post micturition dribble, nocturia, and stress urinary incontinence than non-NE. NE patients had a more parity numbers, diuretic, hypnotic, and prokinetic use, and smoking. NE patients more likely reported fatigue, anxiety, and distress. Urodynamic studies revealed more detrusor overactivity, detrusor underactivity, and low bladder compliance in NE patients. In conclusion, OAB-wet women with NE had more detrusor overactivity, detrusor underactivity, and a lower compliance bladder on urodynamic studies than those without NE. NE impacts the patients' life in aggravating fatigues, anxiety, and distress in OAB-wet women.

Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age

INTRODUCTION AND HYPOTHESIS

The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women.

METHODS

This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review. This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022. The following key words were used "nocturia" and "menopause" or "nocturnal frequency and menopause." Moreover, key words including "incidence," "prevalence," "insomnia," "estrogen therapy," "metabolic syndrome," and "hot flushes" were used in combination with the aforementioned key words. Last, the reference lists of articles obtained were screened for other relevant literature.

RESULTS

The perimenopause can be a trigger for inducing nocturia. Typically, obesity, body mass index (BMI), and waist circumference are risk factors for developing peri-menopausal nocturia. Presumably the development of peri-menopausal nocturia is multifactorial, with interplay among bladder, sleep, and kidney problems due to estrogen depletion after the menopause. First, impaired stimulation of estrogen receptors in the urogenital region leads to vaginal atrophy and reduced bladder capacity. Moreover, menopause is associated with an increased incidence of overactive bladder syndrome. Second, estrogen deficiency can induce salt and water diuresis through blunted circadian rhythms for the secretion of antidiuretic hormone and the activation of the renin-angiotensin-aldosterone system. Additionally, an increased incidence of sleep disorders, including vasomotor symptoms and obstructive sleep apnea signs, is observed. Oral dryness and a consequent higher fluid intake are common peri-menopausal symptoms. Higher insulin resistance and a higher risk of cardiovascular diseases may provoke nocturia. Given the impact of nocturia on general health and quality of life, bothersome nocturia should be treated. Initially, behavioral therapy should be advised. If these modifications are inadequate, specific treatment should be proposed. Systemic hormone replacement is found to have a beneficial effect on nocturia, without influencing sodium and water clearance in patients with nocturnal polyuria. It is presumed that the improvement in nocturia from hormonal treatment is due to an improvement in sleep disorders.

Menopause hormone therapy and urinary symptoms: a systematic review

IMPORTANCE

Urogenital changes associated with menopause are now classified as genitourinary syndrome of menopause (GSM), which includes symptoms of urgency, frequency, dysuria, and recurrent urinary tract infections for which the recommended treatment is estrogen. However, the association between menopause and urinary symptoms and the efficacy of hormone therapy for these symptoms is uncertain.

OBJECTIVE

Our objective was to define the relationship between menopause and urinary symptoms including dysuria, urgency, frequency, recurrent urinary tract infections (UTIs), and urge and stress incontinence by conducting a systematic review of the effects of hormone therapy (HT) for urinary symptoms in perimenopausal and postmenopausal women.

EVIDENCE REVIEW

Eligible studies included randomized control trials with perimenopausal and postmenopausal women with a primary or secondary outcome of the following urinary symptoms: dysuria, frequent UTI, urgency, frequency, and incontinence, included at least one treatment arm of estrogen therapy, and were in English. Animal trials, cancer studies and pharmacokinetic studies, secondary analyses, and conference abstracts were excluded. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched until April 2022. Two authors reviewed each article with discrepancies resolved through whole group consensus. Data extracted included the following: publication date, country, setting, subject number, follow-up, duration, age, race/ethnicity, study design, inclusion criteria, and main findings.

FINDINGS

There is insufficient evidence to confirm that menopause is associated with urinary symptoms. The effect of HT on urinary symptoms depends on type. Systemic HT may cause urinary incontinence or worsen existing urinary symptoms. Vaginal estrogen improves dysuria, frequency, urge and stress incontinence, and recurrent UTI in menopausal women.

CONCLUSIONS AND RELEVANCE

Vaginal estrogen improves urinary symptoms and decreases the risk of recurrent UTI in postmenopausal women.

Prevalence and severity of urinary incontinence and associated factors in Iranian postmenopausal women: a cross-sectional study

BACKGROUND

Urinary incontinence (UI) is one of the most common symptoms during menopause, leading to a decreased quality of life and limited social activities. This study aimed to determine the prevalence and severity of urinary incontinence and associated risk factors in postmenopausal women.

METHODS

It was a cross-sectional study using cluster sampling on 433 postmenopausal women in Tabriz-Iran, 2021-2022. Data were collected using questionnaires of socio-demographic characteristics, Questionnaire for Urinary Incontinence Diagnosis (QUID), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF). Multivariate logistic regression was used to determine factors related to urinary incontinence.

RESULTS

The overall prevalence of urinary incontinence was 39.5%; 20.6% stress urinary incontinence (SUI), 10.4% urgency urinary incontinence (UUI), and 8.5% mixed urinary incontinence (MUI). Multivariate logistic regression analysis showed that the prevalence of SUI (aOR 0.38; 95% CI 0.18-0.77) and UUI (aOR 0.38; 95% CI 0.15-0.94) was significantly lower in women with three childbirths than the ones with fewer childbirths. Also, the odds of UUI increased significantly in women at the 50-55 age range (aOR 3.88; 95% CI 1.16-12.93) than those less than 50 years.

CONCLUSION

Due to the high prevalence of urinary incontinence in postmenopausal women, caregivers should screen for early diagnosis and appropriate treatment of urinary incontinence to prevent its destructive impact on the quality of life.

Early adulthood and current physical activity and their association with symptoms of pelvic floor disorders in middle-aged women: An observational study with retrospective physical activity assessment

OBJECTIVE

To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFDs), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), faecal incontinence (FI), constipation or defecation difficulties (CDDs) and feeling of pelvic organ prolapse (POP) among middle-aged women.

DESIGN

A cross-sectional, observational study with retrospective PA assessment.

SETTING

University Research Laboratory.

SAMPLE

A random population sample of 1098 Finnish women aged 47-55 years.

METHODS

Early adulthood PA, current PA, and demographic and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of PA variables with symptoms of PFDs. Potential confounding effects of demographic and gynaecological variables were controlled in multiple logistic regression models.

MAIN OUTCOME MEASURES

Structured questionnaire-assessed retrospective PA assessment at the age of 17-29 years, current PA at middle age, and prevalence of symptoms of CDD, FI, POP, SUI and UUI.

RESULTS

Current PA was not independently associated with the occurrence of the symptoms of PFDs. Middle-aged women with an early adulthood history of competitive sports were more likely to experience symptoms of UUI (OR 2.16, 95% CI 1.10-4.24, p = 0.025) but not symptoms of SUI, FI, CDD or POP, whereas women with a history of regular PA were more likely to experience symptoms of FI (OR 4.41, 95% CI 1.05-18.49, p = 0.043) but no other symptoms of PFDs.

CONCLUSIONS

Competitive sports during early adulthood may increase the risk of UUI in middle age. Regular PA during early adulthood may increase the risk of FI.

Readjustable Sling in Women With Stress Urinary Incontinence and Hypomobile Urethra: Understanding the Mechanisms of Closure by Transperineal Ultrasound

OBJECTIVES

To assess the postsurgical sonographic parameters of a readjustable sling (RAS) according to urinary incontinence (UI) symptoms after surgery and compare this RAS sonographic pattern with mid-urethral slings (MUS).

METHODS

Observational, prospective multicenter study, including women undergoing stress urinary incontinence (SUI) surgery with RAS (Remeex®). The primary outcome was the association between UI symptoms and sonographic parameters measured by two-dimensional transperineal and high-frequency endovaginal ultrasound. We measured static parameters (bladder neck funneling, RAS position, symmetry, distance to the urethral lumen), and the movement of the sling on Valsalva. UI symptoms were measured with the postsurgical Incontinence Questionnaire-Short Form (ICIQ-UI-SF) questionnaire. We created two control groups including patients with transobturator-MUS (TOT-MUS) and retropubic-MUS (RT-MUS) to compare postsurgical sonographic parameters of RAS with MUS.

RESULTS

Among the 55 women with RAS included, the postoperative ICIQ-UI-SF scores were significantly higher in patients with bladder neck funneling (15.0 (3.9) vs 10.6 (6.7); P = .020) and in those with discordant movement of RAS on Valsalva (14.6 (5.7) vs 10.3 (6.7); P = .045). Compared with the 109 women with TOT-MUS and the 55 with RT-MUS, RAS was more often located in the proximal urethra and farther from the urethral lumen.

CONCLUSIONS

Postsurgical pelvic floor ultrasound demonstrated that in women with complex SUI and hypomobile urethra who underwent RAS (Remeex®) surgery, the presence of bladder neck funneling and discordant movement on Valsalva correlate with the persistence of UI symptoms. In these women, RAS is more often located in the proximal urethra and farther from the urethral lumen at rest in comparison with MUS.

Evaluation of the Pelvic Floor of Women with Breast Cancer Using Tamoxifen by Transperineal 3D Ultrasonography

Objective

This study aimed to investigate the anatomical changes in the pelvic floor of women with breast cancer using tamoxifen by transperineal 3D ultrasonography and their effect on the urinary incontinence and sexual dysfunction.

Methods

Ninety-four patients with breast cancer using TAM in the study group and ninety-five healthy women of the same age in the control group were included in this prospective cohort study. Female Sexual Function Index and Incontinence Questionnaire-Short Form scales were applied to both groups. Ultrasonographic evaluation was performed at resting and Valsalva Maneuver with a convex (3-8 MHz) probe transperineally and the levator urethra gap and levator hiatus diameter were measured after 3-dimensional imaging. Independent t-tests were performed for statistical analysis.

Results

The mean age and body mass index of the experimental group versus control groups were 46.3 ± 6.12 years versus 46.4 ± 5.23 years and 27.6 ± 4.34 kg/m2 versus 29.2 ± 6.45 kg/m2, respectively. LUG and LH values were found significantly higher for the experimental groups compared to control groups at 17.23 ± 2.53 mm versus 14.1 ± 2.23 mm and 21 ± 2.45 cm2 versus 18 ± 4.56 cm2, respectively. (p < 0.05). The FSFI score significantly decreased (12.49 ± 3.58 versus 20.89 ± 3.69) and the ICIQ-SF score increased (4.02 ± 0.34 versus 2.34 ± 0.45) in the experimental group in comparison to control group (p < 0.05).

Conclusion

This study demonstrated that the effects of TAM usage on pelvic floor can be detected by measuring the changes in the levator ani muscle using the transperineal 3D USG. With transperineal USG screening, pelvic floor changes can be early diagnosed and clinical measures can be taken before they become symptomatic.

Risk Factors for Sexual Pain Among Physically Active Women

INTRODUCTION

Sexual pain is common among women but little is known about associations with exercise and physical activity.

AIM

To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors.

METHODS

This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors.

MAIN OUTCOME MEASURE

Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index.

RESULTS

A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain.

CONCLUSION

Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509.

Health seeking behaviour of menopausal women with urinary incontinence in North east Malaysia

Urinary incontinence (UI) is common in women in postmenopausal age, but many women delay seeking treatment. The objective of this study is to determine health-seeking behavior of postmenopausal women with UI and its associated factors. This is a cross-sectional study involving 348 postmenopausal women from the outpatient clinic using personal data forms and a validated UI questionnaire. A total of 348 menopausal women were involved in the study. Only 13.17% of patients with UI sought treatment. Factors associated with seeking treatment were age of menopause and severity of UI. More health education needs to be done among these patients.

The evidence for laser treatments to the vulvo-vagina: Making sure we do not repeat past mistakes

Following menopause, up to 49% of women will experience genitourinary symptoms such as vaginal itching, dryness, dyspareunia and incontinence as a result of oestrogen deficiency. Treatments such as vaginal lubricants and moisturisers only temporarily relieve symptoms, while local oestrogen treatments are often unacceptable or unsafe for many women. Recently, a novel laser treatment has been proposed as a non-invasive, long-term solution to vulvo-vaginal and urinary symptoms. While preliminary histological results have been promising, its therapeutic, clinical effect has yet to be determined. However, despite the scarcity of evidence for its safety and long-term benefit, laser treatments are widely marketed for a range of genitourinary symptoms, with high uptake by both clinicians and women alike. This review aims to examine the evidence for laser treatments to the vulvo-vagina and to evaluate its safety and efficacy. Our results include 17 studies investigating the effect of laser therapy for vulvo-vaginal symptoms, seven for its effects on urinary incontinence and four for histology. These are limited to non-randomised, observational data with small sample sizes between 15 to 175 women and follow-up duration from none to two years. As such, strong evidence for laser efficacy and safety is limited and warrants more robust, placebo-controlled, randomised trials before widespread implementation.

[Evolution of surgical activity related to the female stress urinary incontinence (SUI) with regard to the ageing of the French female population]

INTRODUCTION AND OBJECTIVE

One of the main factors associated with urinary incontinence of women is aging. The total female French population seems to grow for 10 years, with more and more women over 60 years. The authors wanted to assess the evolution of the surgical activity related to the treatment of the urinary incontinence with regard to the aging of the female French population.

MATERIALS AND METHODS

The number of surgical procedures for the treatment of stress urinary incontinence was obtained by querying the database of the Agence Technique de l'Information sur l'Hospitalisation (ATIH) for the period 2002-2013. The Catalogue Des Actes Médicaux (CDAM) and the Classification Commune des Actes Médicaux (CCAM) were used to extract the codes relating to surgery of the female urinary incontinence during this period. Demographics data were obtained from the website of the National Institute of Demographic studies (INED). The results were then compared.

RESULTS

On the 2002-2010 period, the total female French population increased by 5%. In the class of age over 60 years, it increased by 12.7%. Support-related surgical activity continued to decrease until 2013 with 17.3% interventions less than in 2002.

CONCLUSION

The evolution of surgical activity does not seem to follow the evolution of the ageing of the population, even if age is a risk factor essential for the female urinary incontinence. The improvement of risk factors (gynecological, obstetrical), over the past decade, could explain this evolution.

LEVEL OF EVIDENCE

3.

Vasomotor symptoms and urogenital atrophy in older women: a systematic review

OBJECTIVE

Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years.

METHODS

A systematic literature search of English-language publications was performed using MEDLINE, EMBASE, CINAHL, and PsycINFO. Twenty-three studies that included information on the prevalence of vasomotor and/or urogenital atrophy symptoms among older women (65 + years) met our inclusion criteria. Risk of bias of the included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies.

RESULTS

The available data suggest that vasomotor symptoms are experienced by a considerable proportion of older women, that symptoms of urogenital atrophy including urinary incontinence are widespread, and that women remain sexually active well into later life. A high degree of variability was observed for the prevalence of estrogen deficiency symptoms for women age 65+ years. Discrepancies in modes of recruitment, sampling procedures, time frames over which symptoms were assessed and use of different and non-validated assessment tools contributed to the inconsistencies across the published studies.

CONCLUSION

Larger and appropriately sampled studies, employing validated questionnaires, are still needed to establish the prevalence of persistent estrogen depletion symptoms in women aged 65+ years.

Normal reference values of strength in pelvic floor muscle of women: a descriptive and inferential study

Background

To describe the clinical, functional and quality of life characteristics in women with Stress Urinary Incontinence (SUI). In addition, to analyse the relationship between the variables reported by the patients and those informed by the clinicians, and the relationship between instrumented variables and the manual pelvic floor strength assessment.

Methods

Two hundred and eighteen women participated in this observational, analytical study. An interview about Urinary Incontinence and the quality of life questionnaires (EuroQoL-5D and SF-12) were developed as outcomes reported by the patients. Manual muscle testing and perineometry as outcomes informed by the clinician were assessed. Descriptive and correlation analysis were carried out.

Results

The average age of the subjects was (39.93 ± 12.27 years), (24.49 ± 3.54 BMI). The strength evaluated by manual testing of the right levator ani muscles was 7.79 ± 2.88, the strength of left levator ani muscles was 7.51 ± 2.91 and the strength assessed with the perineometer was 7.64 ± 2.55. A positive correlation was found between manual muscle testing and perineometry of the pelvic floor muscles (p < .001). No correlation was found between outcomes of quality of life reported by the patients and outcomes of functional capacity informed by the physiotherapist.

Conclusion

A stratification of the strength of pelvic floor muscles in a normal distribution of a large sample of women with SUI was done, which provided the clinic with a baseline. There is a relationship between the strength of the pelvic muscles assessed manually and that obtained by a perineometer in women with SUI. There was no relationship between these values of strength and quality of life perceived.

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-014-0143-4) contains supplementary material, which is available to authorized users.

Assessment of symptoms of menopause and their severity among Saudi women in Riyadh

BACKGROUND AND OBJECTIVES

Research on menopause in Arab women is limited. The aim of our study was to assess the commonly experienced symptoms of menopause and their severity among Saudi women.

DESIGN AND SETTING

A cross-sectional study conducted at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

Four hundred and ninety healthy women aged 40-55 years and either attending KKUH themselves or accompanying their relatives in outpatient clinics participated in the study. The Menopause Rating Scale (MRS) was used to assess menopausal symptoms and severity.

RESULTS

The mean (SD) age of the women in menopause was 47.9 (6.03) years. The most frequent symptoms were muscle and joint problems occurring in 411 women (83.9%), physical and mental exhaustion in 393 (80.2%), heart discomfort in 358 (73.1%), sleeping disorders in 349 (71.2%), hot flashes in 348 (71.0%), and irritability in 348 (71.0%); in addition, 179 (36.5%) of these women experienced severe psychological distress. Perimenopausal women had higher total and subscales scorings for somatic symptoms than did premenopausal and postmenopausal women (P=.008).

CONCLUSION

The number of Saudi women reporting hot flashes and night sweats was comparable to the number of Western women. In addition, somatic symptoms were more prevalent among perimenopausal than among premenopausal women.

Measuring urinary incontinence in a population of women in northern Mexico: prevalence and severity

INTRODUCTION AND HYPOTHESIS

This study was designed to estimate the prevalence of urinary incontinence and its associated risk factors among women in northern Mexico. The type and severity of incontinence were also assessed.

METHODS

This cross-sectional population-based study assessed self-reported urinary incontinence in a random sample of 1,307 women aged 25-54 years. Logistic regression was used to estimate the association of urinary incontinence with sociodemographic and reproductive characteristics and other medical conditions.

RESULTS

Overall, 18.4% of participants reported having involuntary loss of urine at some time within the last 12 months (95% CI, 16.4-20.7%). Among women reporting urinary incontinence, stress incontinence was the most common form (56.8%), followed by mixed (31.1%) and urge incontinence (10.0%). Approximately half of the women with urinary incontinence symptoms reported a severity index of moderate (25.8%) to severe (26.2%), with 30% stating that their leakage was extremely bothersome. Forty percent of incontinent women reported use of some sort of protection, although only 28% had ever talked to a physician about their symptoms. In adjusted analyses, high body mass index (BMI) ≥ 25 kg/m(2), chronic urinary tract infections, and a history of a hysterectomy or uterine leiomyomata were associated with increased odds of reporting incontinence symptoms. Increased odds of reporting severe urinary incontinence was associated with chronic urinary tract infections, current smoking and high BMI.

CONCLUSION

Our results suggest that there might be a need to develop a culturally sensitive screening questionnaire in order to identify and counsel women with mild incontinence symptoms in the primary care setting.

Loss of adenosine A2B receptor mediated relaxant responses in the aged female rat bladder; effects of dietary phytoestrogens

This study examined the effect of age, ovariectomy and dietary phytoestrogen ingestion on adenosine A(2B) receptor mediated relaxant responses and mRNA expression of adenosine receptor subtypes in the rat isolated bladder. Female Wistar rats (8 weeks) were anaesthetised and the ovaries were removed (ovx) or left intact (sham). Rats were fed either normal rat chow (soy, phytoestrogens) or a non-soy (phytoestrogen free) diet. Isolated bladder from rats aged 12, 24 or 52 weeks were pre-contracted with 3 μM carbachol prior to a concentration response curve to 5'-(N-ethylcarboxamido) adenosine (NECA) being obtained. In 12-week-old rats, the bladder exhibited enhanced relaxant responses to NECA in soy-fed rats (P < 0.05), whilst at 24 weeks of age, the relaxant responses to NECA were attenuated in all the groups studied except soy-treated sham rat bladders in which the relaxant responses were enhanced. At 52 weeks of age, no relaxant effects were observed in any of the treatment groups and NECA-induced contractile responses occurred. In all bladders, the adenosine A(2B) receptor was the most abundantly expressed. In bladders from young and mature female rats, the mRNA expression of adenosine receptors (A(1), A(2A) and A(2B)) was lowest in the bladder from non-soy-fed ovariectomised animals and the use of phytoestrogens in the diet increased the mRNA expression of these receptors (P < 0.05). While a soy diet improves the relaxant effects to the adenosine analogue via adenosine A(2B) receptors in bladders from younger rats, the benefits are lost with advancing age.

Clinical presentation of urinary tract infection (UTI) differs with aging in women

Uncomplicated UTI is among the most common health problems seen in general practice and typically affects immunocompetent, anatomically normal women. The aim of this study was to explore the difference in clinical presentation in acute, uncomplicated UTI in otherwise healthy community dwelling, premenopausal (Pre-M) and postmenopausal (Post-M) women. A UTI was defined as uropathogen of more than 10(3)cfu/ml in midstream urine culture. Symptoms of UTI were divided to three: during voiding, local symptoms, and generalized symptoms. A total of 196 women aged a minimum of 45 years with diagnosis of UTI were studied. The patients were divided into two groups: Pre-M (n=102, mean age 48.14 years) and Post-M (n=94, mean age 69.21 years). The predominant complaints in Pre-M women were local symptoms. The clinical presentations showed more severity in the Post-M group than in Pre-M women, predominantly generalized unspecific symptoms and storage symptoms. Advanced age positively correlated with urgency of urination, painful voiding, urinary incontinence, sexual activity, low-back pain, lower abdominal pain and negatively correlated with frequency, painful and burning of urination and bladder pain. Our study showed that clinical presentation of UTI in Pre-M and Post-M women is different. The differences are presented not only by the voiding itself and by local symptoms but also by unspecified generalized symptoms that is especially important in elderly patients.

Assessment of menopausal symptoms using modified Menopause Rating Scale (MRS) among middle age women in Kuching, Sarawak, Malaysia

BACKGROUND

Menopausal symptoms can be assessed by several tools, and can be influenced by various socio-demographic factors.

OBJECTIVES

To determine the commonly reported menopausal symptoms among Sarawakian women using a modified Menopause Rating Scale (MRS).

METHODS

By using modified MRS questionnaire, 356 Sarawakian women aged 40-65 years were interview to document of 11 symptoms (divided into somatic, psychological and urogenital domain) commonly associated with menopause.

RESULTS

The mean age of menopause was 51.3 years (range 47 - 56 years). The most prevalent symptoms reported were joint and muscular discomfort (80.1%); physical and mental exhaustion (67.1%); and sleeping problems (52.2%). Followed by symptoms of hot flushes and sweating (41.6%); irritability (37.9%); dryness of vagina (37.9%); anxiety (36.5%); depressive mood (32.6%). Other complaints noted were sexual problem (30.9%); bladder problem (13.8%) and heart discomfort (18.3%). Perimenopausal women (n = 141) experienced higher prevalence of somatic and psychological symptoms compared to premenopausal (n = 82) and postmenopausal (n = 133) women. However urogenital symptoms mostly occur in the postmenopausal group of women.

CONCLUSIONS

The prevalence of menopausal symptoms using modified MRS in this study correspond to other studies on Asian women however the prevalence of classical menopausal symptoms of hot flushes, sweating was lower compared to studies on Caucasian women.

The menopausal experience among indigenous women of Sarawak, Malaysia

OBJECTIVES

To document the common menopausal symptoms and quality of life in indigenous women of Sarawak in Malaysia.

METHODS

A face-to-face interview using the Menopause-specific Quality of Life questionnaire was conducted with 276 indigenous Sarawakian women aged 40-65 years to determine the mean age of menopause and common symptoms (divided into vasomotor, psychosocial, physical and sexual domains) associated with menopause.

RESULTS

The mean age at menopause of postmenopausal women was 50.78 +/- 2.47 years (range 47.3-58.2 years). The most common symptoms reported were aching in muscles and joints (82.6%), lack of energy (77.5%) and low backache (77.2%). The typical menopausal symptoms of hot flushes, night sweats, sweating and vaginal dryness were experienced by 42.4%, 34.8%, 29.7% and 49.3%, respectively of the women studied. Perimenopausal women (n = 114) experienced the most physical and psychosocial symptoms, while postmenopausal women (n = 102) experienced most sexual symptoms. Perimenopausal and postmenopausal women were reported to suffer more than premenopausal women (p < 0.001) within the four domains of symptoms (vasomotor, psychosocial, physical and sexual).

CONCLUSIONS

The menopausal symptoms in this study correspond to those in other studies on Asian women but the prevalence of typical and classical menopausal symptoms was lower compared to studies on Caucasian women. The perimenopausal women had the most significant decrease in quality of life, followed by postmenopausal women and premenopausal women. Vasomotor symptoms had a predominant influence on the quality of life.

A prospective study of outcomes after hysterectomy in mid-aged Australian-born women

OBJECTIVE

To describe the prevalence of hysterectomy in a mid-aged population-based sample of Australian-born women who were menstruating at baseline and followed for 11 years, and to compare the hysterectomized women with the non-hysterectomized women with regard to symptom reporting and health outcomes.

METHODS

This was a 12-year prospective observational study of 438 women who at baseline were aged 45-55 years, not taking hormone therapy (HT) and had menstruated in the previous 3 months. Interviews were conducted face-to-face.

RESULTS

After 11 years of follow-up, 39 (9%) women had experienced a hysterectomy, of whom 43.5% had the uterus only removed, 13% had the uterus plus one ovary and 43.5% had the uterus and both ovaries removed. Hysterectomies were performed on average 5.8 years prior to the year 11 interview. The mean age at hysterectomy was 54 years. Multivariate logistic regression analysis, including all co-variates, found that women who had experienced a hysterectomy (+/-oophorectomy) were significantly more likely to complain of trouble sleeping (p < 0.01), have problems with urine control (p < 0.05) and with their bowels (p = 0.07), have used HT (p < 0.05) and have a higher body mass index (p < 0.05). There were no significant associations between hysterectomy and sexuality or hot flush reporting.

CONCLUSION

In a community-based sample of Australian-born women, the experience of a hysterectomy after the age of 45 years was associated with bladder, weight and sleeping problems 5-6 years after the surgery.

Urogenital effects of selective estrogen receptor modulators: a systematic review

OBJECTIVE

Selective estrogen receptor modulators (SERMs) include a relatively large number of compounds, each with different profiles of estrogenic/antiestrogenic actions on the genital tract. The aim of this review was to systematically evaluate all the available data from randomized, controlled studies on the effects of these compounds on pelvic organ prolapse and urinary incontinence.

METHODS

Literature searches were performed using three computerized databases to identify the result of all randomized, controlled trials performed with SERMs having any effects on pelvic floor as an outcome. A manual search was performed on all related articles.

RESULTS

We have identified only one randomized, placebo-controlled trial specifically designed to assess the effect of raloxifene and tamoxifen on the urogenital tract. Most of the data on genitourinary effects of various compounds derive from either questionnaires or adverse events reported during phase III clinical trials. Both tamoxifen and raloxifene appear to increase the incidence of pelvic floor prolapse in one trial, although this was not apparent from the licensing studies data for either of the drugs. Raloxifene does not appear to increase the incidence of urinary incontinence. Levormeloxifene and idoxifene, on the contrary, were noted to increase uterine prolapse and incontinence during phase III trials that prematurely terminated. No data are available on the genitourinary effect of toremifene and on the newer SERMs currently undergoing phase III trials: basedoxifene, lasofoxifene, and arzoxifene.

CONCLUSION

Contrary to their effects in bone, SERMs do not have a class-specific effect on the genitourinary tract. In fact, compounds that are more estrogenic on the uterus such as levormeloxifene and idoxifene also increase the risk of prolapse and incontinence. SERMs can adversely affect the pelvic floor and incontinence but data from urodynamic studies are not yet available. Data on prolapse are contradictory. Given the increased incidence of prolapse and incontinence observed in several licensing trials, more focused research on the effect of these molecules on pelvic floor function is needed.

Dyspareunia in postmenopausal women: a critical review

BACKGROUND

Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.

OBJECTIVES

To critically review the literature on the prevalence, risk factors, etiology, clinical presentation and treatment of postmenopausal dyspareunia. The present review also examines the traditional and widely held conceptualization of postmenopausal dyspareunia as a direct symptom of hormonal decline.

METHODS

Searches of medical and psychological databases were performed for relevant articles and empirical studies. The methodological quality and outcomes of the studies were systematically reviewed.

RESULTS

Available empirical evidence suggests that dyspareunia is common in postmenopausal women, and that it is not highly correlated with menopausal status, estrogen levels or vaginal atrophy. Decreasing levels of endogenous estrogen contribute to the development of dyspareunia in postmenopausal women suffering from vaginal atrophy. Hormonal supplementation is beneficial in alleviating their pain. However, a substantial proportion of treated women do not report relief.

CONCLUSIONS

Postmenopausal dyspareunia occurring concurrently with vaginal atrophy is strongly associated with a lack of estrogen in the genital tract. However, a significant percentage of postmenopausal women experience dyspareunic pain that is not caused by hypoestrogenism. It is likely that other types of dyspareunia that occur premenopausally are also occurring in postmenopausal women. Research is needed to adequately address this issue. A change in perspective toward a multiaxial pain-focused approach is proposed for future research concerning dyspareunia in postmenopausal women.

Reproductive factors associated with nocturia and urinary urgency in women: a population-based study in Finland

OBJECTIVE

The objective of this study was to evaluate the association of nocturia and urinary urgency with reproductive factors, including parity, the postpartum period, the menopause, hormone replacement therapy, hysterectomy, and surgery for stress urinary incontinence (SUI).

STUDY DESIGN

In 2003-2004, questionnaires eliciting urinary symptoms, reproductive factors, SUI surgery, and potential confounders were mailed to 3000 randomly selected women aged 18-79 years, identified from the Finnish Population Register. Nocturia was defined as 2 or more voids/night. Sudden compelling desire to urinate often or always (scale of never, rarely, often, always) was regarded as urgency. Pregnant and puerperal (6 weeks after delivery) women and those reporting urinary tract infection were excluded.

RESULTS

Responses totaled 2002 (67%). Parity, postpartum (defined as six weeks to one year after delivery) and postmenopausal periods were associated with increased nocturia and SUI surgery with increased urgency (adjusted for age, comorbidity, medication, anthropometric, sociodemographic and lifestyle factors). Hormone therapy and hysterectomy were associated with neither symptom.

CONCLUSION

Reproductive factors associated with nocturia differed from those related to urgency.

Comparison of the long-term effects of simple total abdominal hysterectomy with transcervical endometrial resection on urinary incontinence

OBJECTIVE

To test the hypothesis that the hospital referral rate for urinary incontinence (UI) symptoms, within 10 years of a simple total abdominal hysterectomy (TAH) for dysfunctional uterine bleeding (DUB), would differ to that after a transcervical resection of the endometrium (TCRE).

DESIGN

Retrospective case note review.

SETTING

Teaching hospital in north east Scotland.

POPULATION

All women who had a TAH (316) or a TCRE (229) for DUB, during the period from 1 January 1990 to 31 December 1994, who had never been referred for symptoms of UI prior to their operation.

METHODS

Independent t tests, Mann-Whitney U tests and Chi-squared tests were used to compare the two study groups in terms of demographic details and outcome measures. Newcombe's method for the comparison of two unpaired proportions was used to calculate 95% CIs for the differences in outcome measures between the two operations. Logistic regression was conducted to investigate associations with hospital referral for UI.

MAIN OUTCOME MEASURES

Hospital referral for UI at 10 years follow up.

RESULTS

There were significantly more hospital referrals for UI in the TAH group compared with the TCRE group (46 [15%] versus 16 [7%]; OR 2.27, 95% CI 1.25-4.12). More women were referred for urological investigations after a TAH than after a TCRE (39 [12%] versus 13 [6%], 95% CI for the difference in proportions 2-11%). A higher, but statistically nonsignificant, proportion of women had objectively demonstrated UI after a TAH than after a TCRE (25 [8%] versus 10 [4%], 95% CI for the difference in proportions -1 to 8%). There were a greater number of hospital referrals for treatment of UI in the TAH group (36, 11%) than in the TCRE group (12, 5%), 95% CI for the difference in proportions (1-11%). After adjusting for age, weight, smoking status and mode of delivery, the increased rate of hospital referral for UI after TAH remained, with an odds ratio of 2.31, 95% CI 1.24-4.30.

CONCLUSIONS

TAH is associated with a significantly increased incidence of hospital referral for UI, urological investigations and treatment for UI at 10 years of follow up compared with TCRE.

Modeling response rates in surveys of female sexual difficulty and dysfunction

INTRODUCTION

Studies that address sensitive topics, such as female sexual difficulty and dysfunction, often achieve poor response rates that can bias results. Factors that affect response rates to studies in this area are not well characterized.

AIM

To model the response rate in studies investigating the prevalence of female sexual difficulty and dysfunction. Methods. Databases were searched for English-language, prevalence studies using the search terms: sexual difficulties/dysfunction, woman/women/female, prevalence, and cross-sectional. Studies that did not report response rates or were clinic-based were excluded. A multiple linear regression model was constructed.

MAIN OUTCOME MEASURES

Published response rates.

RESULTS

A total of 1,380 publications were identified, and 54 of these met our inclusion criteria. Our model explained 58% of the variance in response rates of studies investigating the prevalence of difficulty with desire, arousal, orgasm, or sexual pain (R(2) = 0.581, P = 0.027). This model was based on study design variables, study year, location, and the reported prevalence of each type of sexual difficulty. More recent studies (beta = -1.05, P = 0.037) and studies that only included women over 50 years of age (beta = -31.11, P = 0.007) had lower response rates. The use of face-to-face interviews was associated with a higher response rate (beta = 20.51, P = 0.036). Studies that did not include questions regarding desire difficulties achieved higher response rates than those that did include questions on desire difficulty (beta = 23.70, P = 0.034).

CONCLUSION

Response rates in prevalence studies addressing female sexual difficulty and dysfunction are frequently low and have decreased by an average of just over 1% per anum since the late 60s. Participation may improve by conducting interviews in person. Studies that investigate a broad range of ages may be less representative of older women, due to a poorer response in older age groups. Lower response rates in studies that investigate desire difficulty suggest that sexual desire is a particularly sensitive topic.

Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up?

OBJECTIVE

The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy.

STUDY DESIGN

One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001.

RESULTS

Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6+/-2.2 years (range 1.5-11) after vaginal hysterectomy and 4+/-1.8 years (range 1.5-7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups.

CONCLUSION

This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.

Urogenital symptoms of postmenopausal women in Turkey

OBJECTIVE

The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey.

DESIGN

The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice.

RESULTS

The mean age of participants was 58.64 +/- 8.14 years. The mean age of menopause was 47.21 +/- 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency.

CONCLUSIONS

Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.

Tension-free vaginal tape for the treatment of stress urinary incontinence in geriatric patients

OBJECTIVE

To evaluate the safety and efficacy of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in geriatric patients.

PATIENTS AND METHODS

Fifty-one women, aged 65-80 (mean 72.3) years, underwent a TVT procedure for genuine SUI from 2001 to 2004. A urodynamic test together with uroflowmetry were performed. The patients' SUI bother score was assessed using a visual analog scale (VAS).

RESULTS

The mean operative time was 25 (range 14-29) min and mean hospitalization time was 1.2 (range 1-2) days. Bladder perforation occurred in 3 cases (5.8%) and was managed conservatively. Pre- and postoperative maximum flow rate were not significantly different (p > 0.05). The patients' SUI bother score estimated by the VAS was statistically significantly improved (p < 0.0001). After a mean follow-up of 35.6 (range 14-60) months, 49 patients (96%) had no SUI, while 2 patients (3.9%) had persistent SUI. Also, during the follow-up 5 patients (9.8%) were diagnosed with de novo urgency due to detrusor overactivity and 1 patient (1.9%) had persistent dysuria that was resolved with urethrolysis.

CONCLUSIONS

SUI in elderly women can be safely treated with the TVT procedure in the vast majority of the patients. However, bladder perforation during surgery and de novo urgency postoperatively should be taken into account.

Urodynamic and morphologic changes in the lower portion of the urogenital tract after administration of estriol alone and in combination with phenylpropanolamine in sexually intact and spayed female dogs

OBJECTIVE

To compare the urodynamic and morphologic effects of the administration of estriol alone and in combination with phenylpropanolamine on the lower portion of the urogenital tract in female dogs.

ANIMALS

3 sexually intact and 3 spayed female Beagles without urinary incontinence.

PROCEDURE

Dogs received estriol (2 mg, PO) once daily for 7 days followed by estriol (2 mg, PO) and phenylpropanolamine (1.5 mg/kg, PO) once daily for 7 days. Urethral pressure profilometry, diuresis cystometry, and vaginourethrography were performed before treatment (day 0) and at days 7 and 14. The maximum urethral pressure (MUP) and closure pressure (MUCP), urethral functional and anatomic profile lengths, integrated pressure (IP), plateau, distance before MUP, maximum meatus pressure, threshold pressure, threshold volume, compliance, urethral length, and vaginal length and width were measured.

RESULTS

Before treatment, no urodynamic differences were observed between the 2 groups; however, vaginal length and width were significantly shorter in spayed dogs. Compared with day 0 values, estriol treatment significantly increased MUP, MUCP, and IP values at day 7, but at day 14, this effect decreased despite phenylpropanolamine administration. No morphologic changes from baseline were detected after either treatment in any dog.

CONCLUSIONS AND CLINICAL RELEVANCE

Data suggest that estriol mainly acts on the urethral sphincter mechanism by increasing urethral resistance in sexually intact and spayed female dogs without urinary incontinence. Administration of estriol and phenylpropanolamine did not increase the urethral resistance more than estriol alone. The urodynamic effects of estriol in female dogs with urinary incontinence remain to be elucidated.

Expression of vascular endothelial growth factor in the lower urinary tract in rats after castration and estrogen administration

OBJECTIVE

To evaluate quantitatively, by means of immune histochemistry, the expression of the vascular endothelial growth factor (VEGF) in the bladder, vesicourethral junction, and urethra in normal, castrated adult rats and under estrogen administration.

DESIGN

Sixty adult virgin rats (Rattus norvergicus albinus, Rodentia, Mammalia) from the CEDEME-UNIFESP Animal House were used. Rats were divided into three groups. Group I comprised noncastrated rats, group II comprised oophorectomized rats, and group III comprised castrated rats administered 17beta-estradiol in the form of subcutaneous implants at the dose of 0.18 mg/implant for 30 days. After performing standard immunohistochemistry procedures, the intensity of the dark-brown color was used as the cytoplasmic protein expression of VEGF. Cells without this coloration or weakly stained were considered negative. percentile of VEGF expression was obtained by counting 1,000 cells per slide and establishing the ratio between positive and total cells.

RESULTS

The VEGF expression was uniform and similar along the urinary tract in group I. After castration, protein expression was almost absent in the bladder and was low in the vesicourethral junction and urethra. With estrogen replacement, very little of the expression was recovered in the bladder, and the reaction became evident in the vesicourethral junction and urethral sections.

CONCLUSIONS

The present study implies a potential relationship between VEGF and urinary tract physiology. The results suggest that there are quantitative differences in VEGF expression in these tissues depending on steroid hormone status.

What affects the occurrence of nocturia more: menopause or age?

OBJECTIVES

Prevalence studies show that nocturia is a very common condition, affecting older age groups in particular. In this study, we evaluate (1) the community-based prevalence of nocturia and its associated overactive bladder according to the patient's perception and disturbance to sleep and (2) whether age or menopausal (MP) transition has a greater effect on the occurrence of nocturia.

METHODS

The questions regarding nocturia were part of the Bristol female lower urinary tract symptoms questionnaire (translated into Mandarin, the correlation coefficient r = 0.91). A total of 1253 (79.1% response rate) women were randomly sampled from a community-based female population, aged 20 years or older. Samples were subdivided into reproductive age, perimenopausal stage and elderly. If the participants reported having nocturia, they were further questioned with, "Does it interfere with your sleep or bother your daily life?" The chi-square test and the Cochran-Armitage trend test were used to analyze the data.

RESULTS

Nocturia in older age groups was significantly higher than that of the younger age groups. The occurrence of nocturia was significantly associated with the elderly (compared with the reproductive age, P < 0.05). There were no significant differences in the prevalence of nocturia between the perimenopausal stage and the reproductive age (P > 0.05).

CONCLUSIONS

Our data implies that the increasing occurrence of nocturia is age-related and is not affected by the transition from pre- to postmenopause. Large-scale prospective longitudinal studies need to be conducted to clarify the effects of the aging process and estrogen deficiency.

A study on urogenital complaints of postmenopausal women aged 50 and over

OBJECTIVE

The objective of this study was to determine the prevalence of urogenital complaints in postmenopausal women aged 50 and over.

METHODS

The study was carried out in the city of Istanbul on women within the age range of 50 and over. The statistical figures for these women were obtained from the latest national census. The number of sampling was determined to be 500, each representing a population of 10,000 women. Thus, the sampling consisted of 500 postmenopausal women who had applied to various health centers either to seek remedy for their health problems other than urinary incontinence (UI) or to accompany inpatients. Women in the surgical stage of menopause were excluded from the study group. A specifically designed questionnaire was used to gather data on urogenital complaints. The data obtained by this means was analyzed according to Thomas criteria, which classifies incontinence as rare, regularly and serious. UI was defined according to the International Continence Society (ICS) classification.

RESULTS

Of the interviewees 68.8% reported UI, 28.8% of whom had serious UI requires continuously the use of ped. It was determined that 37.2% of the women with UI had stress incontinence symptoms, 32.3% urge incontinence symptoms, and 30.5% mixed incontinence. Of the women 46.5% had UI problems for 5 years or longer, and 75% reported that their complaints had started after menopause; 18.2% of the women suffered from vaginal discharge and pruritus, while 23% experienced vaginal dryness; 51.2% of the women were sexually active. However, 83.6% of this group of women reported a decrease in sexual desire and frequency of intercourse. Likewise, 78.1% experienced a decline in sexual satisfaction, 77.7% difficulty in having orgasm, and 45.3% dyspareunia. Logistic regression analysis showed that existence of a chronic illness, frequent urethral infections, a high value of body mass index and chronic constipation increased the prevalence of UI.

CONCLUSIONS

Urinary incontinence and sexual problems, particularly decline in sexual desire, are widespread among postmenopausal women. Frequent urinary tract infections, obesity, chronic constipation and other chronic illnesses seem to be the predictors of UI.

Self-reported urogenital symptoms in postmenopausal women: Women’s Health Initiative

OBJECTIVE

To examine the prevalence and correlates of self-reported urogenital symptoms (dryness, irritation or itching, discharge, dysuria) among postmenopausal women aged 50-79.

DESIGN

A cross-sectional analysis based on n=98,705 women enrolled in the US-based Women's Health Initiative observational study and clinical trials. Urogenital symptoms, symptom severity (mild, moderate, severe), and all covariates were self-reported through questionnaires at enrollment. Prevalence rates of each urogenital symptom were examined and logistic regression was used to identify potential correlates.

RESULTS

Prevalence rates for each symptom were: dryness, 27.0%; irritation or itching, 18.6%; discharge, 11.1%; and dysuria, 5.2%. Four factors were correlated with two or more symptoms: Hispanic ethnicity (adjusted odds ratio (AOR)=2.1-3.1 versus white women across all symptoms), obesity (AOR=2.2 severe discharge versus none, AOR=3.6 severe irritation/itching versus none), treated diabetes (pills or shots) compared to no diabetes (AOR=2.4 severe dysuria versus none, AOR=3.2 severe irritation/itching versus none), and vaginal cream HRT/ERT compared to those who never used HRT/ERT (AOR=4.4 severe dryness versus none, AOR=4.6 severe irritation/itching versus none). Factors not associated with the symptoms included sexual activity, age, years since menopause, current smoking, marital status, gravidity, and natural versus surgical menopause.

CONCLUSIONS

This is the first report to document urogenital symptoms by race/ethnicity among an exclusively postmenopausal population. We found an elevated prevalence of urogenital symptoms among women who are Hispanic, obese, and/or diabetic. Confirmation of our findings in these subgroups, and, if confirmed, analysis on why these populations are at greater risk, are areas for future research.

The outcome of pelvic examinations in women 40-60 years of age with lower urinary tract symptoms

We set out to assess the outcome of pelvic examination in women 40-60 years of age with one or more lower urinary tract symptoms. This was an ongoing longitudinal cohort study set in one rural and one urban county in Denmark. One hundred and ninety-six women with one or more lower urinary tract symptoms occurring at least weekly were selected at random. Ages ranged from 40 to 60 years. Pelvic findings involving genital prolapse, signs of vaginal atrophy, and pelvic mass as well as a history of hormonal status and estrogen deficiency symptoms were documented and assessed. One hundred and six women (54.1%) were recruited. First degree cystocele, rectocele, and uterine prolapse occurred in 24 (22.6%), seven (6.6%), and six (5.7%), women respectively. No significant association between first-degree genital prolapse and subtypes of lower urinary tract symptoms (LUTS) was observed. The number of women with second or third degree cystocele, rectocele, and uterine prolapse was three (2.8%), two (1.9%), and two (1.9%), respectively. The positive predictive vaginal findings in each subtype of LUTS indicating an oestrogen deficiency were in the interval 72.0- 90.0 while the negative predictive vaginal findings were in the interval 24.7-27.6%, respectively. In six women (5.7%) a leiomyoma was observed. In one woman the size of the uterus exceeded the size of a 12-week pregnancy. Genital prolapse more than first degree and pelvic masses were infrequent findings among women with LUTS. Signs of vaginal atrophy associated poorly with a history of hormonal depletion and symptoms indicating oestrogen deficiency. However even an infrequent pathologic finding is significant. Therefore we still recommend pelvic examinations in all women with LUTS.

Risk of urge and stress urinary incontinence at long-term follow-up after vaginal hysterectomy

OBJECTIVE

The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy.

STUDY DESIGN

One hundred seventeen patients who had a vaginal hysterectomy for menorrhagia from January 1991 to December 2001 answered a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001.

RESULTS

Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the 2 groups. Mean follow-up was 4.6+/-2.2 years (range, 1.5-11 years) after vaginal hysterectomy and 4+/-1.8 years (range, 1.5-7 years) after conservative treatment. The prevalence of urinary symptoms, which included urge and stress incontinence, was statistically similar in the 2 groups.

CONCLUSION

This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.

A review of symptoms commonly associated with menopause: implications for clinical neuropsychologists and other health care providers

Menopause is a process, either naturally or medically induced, that occurs in nearly all women at some point in life. Some of the most commonly reported symptoms associated with menopause are hot flushes/flashes, fatigue, headaches, irritability, insomnia, and depression. These symptoms overlap with symptoms commonly reported in Traumatic Brain Injury (TBI) as well as postconcussive syndrome. This overlap between symptoms commonly associated with menopause and neuropsychological conditions makes it necessary to have the base rates of these symptoms and conditions available. The purpose of the present review was to consolidate the clinical literature on the most commonly reported menopausal symptoms and to calculate the base rates associated with these symptoms.

Menopause

Elevating women from the nadir of ovarian hypofunction has been a major driving force in developing hormonal strategies for the management of menopause. As indicated by recent evidence, however, this may have resulted in unacceptable morbidity in several women. Likewise, the use of menstrual cessation as the hallmark of menopause may have served the counterproductive effect of delaying the onset of appropriate preventive pharmacologic and non-pharmacologic strategies until the later years of life. Preventive and therapeutic strategies that target the menopausal phase of life exclusively are grossly inadequate. Unquestionably, the controversies that surround the precise health implications of menopause deal mainly with the risk of chronic disease. Health professionals are best advised to develop menopausal intervention strategies that parallel the continuum of a woman's life, beginning in adolescence and extending into later life. Preventive screening includes the following: History Relevant medical history Develop risk profile of chronic diseases (e.g., cardiovascular disease, cancer, osteoporosis) Dietary history Sexual history Physical exercise history Medication history Physical examination Body mass index evaluation Breast examination and instruction in examination technique Bimanual pelvic examination Nutritional assessment Investigation Cholesterol levels Stool for occult blood Thyroid function tests Papanicolaou smears HIV testing if positive risk factors Psychosocial evaluation Family relationships Job satisfaction Sexuality High-risk social behaviors Review perception of self-health Annual health examination is encouraged in all perimenopausal women. Additionally, preventive screening should be instituted, as appropriate, in all women of reproductive age.