Hillard Timothy
Department of Obstetrics and Gynaecology, Poole Hospital NHS Foundation Trust, Poole, UK.
Menopause Int. 2010 Jun;16(2):74-80. doi: 10.1258/mi.2010.010020.
The bladder and its surrounding structures are rich in estrogen receptors and there are demonstrable physiological and anatomical changes that occur around and immediately after the menopause. The prevalence of many bladder symptoms, such as frequency, urgency and incontinence, does seem to increase around the menopause, but there is continuing debate over whether these effects are due to ageing, menopause or a combination of the two. The impact of the menopause varies with individual symptoms; stress urinary incontinence being associated more with estrogen deficiency than urge incontinence which seems to be more age-related. Both estrogen and progesterone have a variety of effects on the urogenital tract which are reviewed. Based on these effects, it could be anticipated that estrogen replacement would have a positive effect on bladder symptoms. However, the data are far from clear cut on this issue. It seems that topical estrogens do have some positive effects, particularly on symptoms of urgency, frequency and urge incontinence, the prevention of urogenital atrophy and in the prevention of recurrent urinary tract infections. The role of systemic estrogens is less clear cut with some studies even suggesting they can be associated with a worsening of some symptoms. The possible explanations for this apparent contradiction are explored, but based on current evidence, it would appear preferable to use vaginal estrogens rather than systemic as part of the management of menopause-related bladder problems.
膀胱及其周围结构富含雌激素受体，在绝经前后及绝经后会出现明显的生理和解剖学变化。许多膀胱症状，如尿频、尿急和尿失禁的患病率在绝经前后似乎确实会增加，但对于这些影响是由于衰老、绝经还是两者共同作用，仍存在持续的争论。绝经的影响因个体症状而异；压力性尿失禁与雌激素缺乏的关联比急迫性尿失禁更强，急迫性尿失禁似乎与年龄关系更大。雌激素和孕激素对泌尿生殖道有多种作用，本文对此进行了综述。基于这些作用，可以预期雌激素替代疗法对膀胱症状会有积极影响。然而，在这个问题上的数据远不明确。局部用雌激素似乎确实有一些积极作用，特别是对尿急、尿频和急迫性尿失禁症状、预防泌尿生殖道萎缩以及预防复发性尿路感染。全身用雌激素的作用不太明确，一些研究甚至表明它们可能与某些症状的恶化有关。本文探讨了这种明显矛盾的可能解释，但基于目前的证据，在管理与绝经相关的膀胱问题时，使用阴道雌激素而非全身用雌激素似乎更可取。
