Urinary incontinence Studies suggest that between 10 and 20 per cent of women over 60 have frequent urinary tract infections. One study of more than 900 postmenopausal women revealed that around one in three women over 60 was bothered by urinary incontinence. As with vaginal symptoms and urinary tract infections, the prevalence of urinary incontinence increases with age; for example, in a Swedish study more than 50 per cent of an older study group reported daily urine loss. Urinary incontinence is a complex problem because there are different types of incontinence and a variety of different possible causes, ranging from anxiety to neurological disorders. Because of its prevalence among postmenopausal women and the fact that many of them report the start of their complaints during or after the menopause, estrogen deficiency has also been investigated as a specific cause. Atrophic changes in the lower urogenital tract are recognised as predisposing factors for incontinence problems. Since estrogen therapy improves the condition of local urogenital tissues, it may at least improve this condition. Because of the often several causes of incontinence, it cannot be expected to be curative in the majority of women; estrogen therapy should therefore be considered as supportive therapy and may be even more effective when combined with other treatments.
http://www.menopause.net/incontinence.html ____________________________________ Local urogenital symptoms are very common in postmenopausal women; their incidence increases with age. Studies show that more than 50 per cent of women over the age of 60 are, to some degree, troubled by such local symptoms. The decline in estrogen levels during and after the menopause means that tissue cells in the vagina and lower urinary tract are not stimulated as before; this results in thinning of the surface - a condition doctors call atrophy . The most commonly seen consequences of atrophy are: vaginal dryness painful intercourse (dyspareunia) itching and irritation (pruritus) discharge Unlike vasomotor symptoms, vaginal symptoms are not transient and tend to become more prevalent and severe with increasing age. Atrophy of the bladder and/or urethra may lead to urinary incontinence problems. This, in combination with atrophy in the vagina may encourage recurring urinary tract infection. Both can be associated with estrogen deficiency, and cause severe quality-of-life problems. ________________________________________ When does estrogen replacement therapy improve sleep quality? Polo-Kantola P, Erkkola R, Helenius H, Irjala K, Polo O Department of Obstetrics and Gynecology, Turku University Central Hospital, Finland. _object_IVE: Our purpose was to evaluate the effect of estrogen replacement therapy on sleep complaints by postmenopausal women and to assess the predictive factors involved. STUDY DESIGN: Sixty-three postmenopausal women entered a 7-month prospective, randomized, double-blind, crossover study consisting of two 3-month treatments with estrogen and placebo with a 1-month washout period between. Eight Visual Analogic Scale statements about different sleep complaints, the Basic Nordic Sleep Questionnaire, scoring of climacteric symptoms, The Beck Depression Inventory, and serum estradiol and follicle-stimulating hormone level controls were the main outcome measures. RESULTS: Estrogen replacement therapy improved sleep quality, facilitated falling asleep, and decreased nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy. Estrogen-induced sleep improvement was associated with alleviation of vasomotor symptoms (r range 0.27 to 0.55), alleviation of somatic symptoms (palpitations and muscular pain, r range 0.26 to 0.36), and alleviation of mood symptoms (r range 0.28 to 0.37) on estrogen replacement therapy. The severity of initial insomnia predicted only one estrogen-induced sleep improvement effect: the more the subjects experienced insomnia, the better the estrogen replacement therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen-induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores strongly predicted estrogen-induced sleep improvement (r range 0.50 to 0.75). CONCLUSIONS: Estrogen replacement therapy significantly diminished sleep complaints among postmenopausal women. Alleviation of climacteric symptoms was the most important predictive factor for the beneficial effect of estrogen replacement therapy on sleep complaints. The use of estrogen replacement therapy in women without self-reported climacteric symptoms could also be considered because women do not always recognize their climacteric symptoms or they ignore them. ______________________________________ In a recent Women and Sleep Poll designed to examine the relationship between sleep and the life stages of women, the National Sleep Foundation (NSF) found that menopausal and post-menopausal women sleep less than pre-menopausal women who are not pregnant. This unique poll assessed the sleep habits, consequences of those habits, and the prevalence of sleep problems and disorders among women 30 to 60 years of age. In the telephone survey of 1,012 women, of whom 38 percent were menopausal or post-menopausal, respondents said menopause not only affects length of sleep, but, more importantly, it diminishes their quality of sleep. In fact, the Women and Sleep Poll reports 100 percent of those women taking hormone replacement therapy agree that it is somewhat to very effective as a sleep aid In the telephone survey of 1,012 women, of whom 38 percent were menopausal or post-menopausal, respondents said menopause not only affects length of sleep, but, more importantly, it diminishes their quality of sleep.
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