Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
Int Urogynecol J. 2024 May;35(5):935-946. doi: 10.1007/s00192-024-05743-1. Epub 2024 Mar 4.
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.
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.
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.
本综述的目的是讨论绝经与夜尿症之间的联系，并概述围绝经期妇女夜尿症的发病率增加、风险因素、病因、治疗需求和选择。
这是一篇基于各种主要意见领袖的专业知识和共识的叙述性综述，结合广泛的文献综述。这项文献搜索包括对 PubMed 数据库和 Web of Science 上的潜在出版物进行彻底分析，搜索时间为 2022 年 11 月至 2022 年 12 月。使用了以下关键词：“夜尿症”和“绝经”或“夜间频率和绝经”。此外，还使用了“发生率”、“患病率”、“失眠”、“雌激素治疗”、“代谢综合征”和“热潮红”等关键词，并与上述关键词结合使用。最后，筛选了获得的文章的参考文献列表，以寻找其他相关文献。
围绝经期可能是引发夜尿症的一个因素。通常，肥胖、体重指数（BMI）和腰围是发生围绝经期夜尿症的风险因素。围绝经期夜尿症的发生可能是多因素的，由于绝经后雌激素的耗竭，膀胱、睡眠和肾脏问题相互作用。首先，雌激素受体在泌尿生殖区的刺激受损会导致阴道萎缩和膀胱容量减少。此外，绝经后还会出现更频繁的膀胱过度活动症。其次，雌激素缺乏会通过抑制抗利尿激素的昼夜分泌和激活肾素-血管紧张素-醛固酮系统引起盐和水利尿。此外，睡眠障碍的发生率增加，包括血管运动症状和阻塞性睡眠呼吸暂停迹象。口腔干燥和相应的更高的液体摄入是常见的围绝经期症状。更高的胰岛素抵抗和心血管疾病风险可能会引发夜尿症。鉴于夜尿症对整体健康和生活质量的影响，应治疗有困扰的夜尿症。首先，应建议进行行为治疗。如果这些改变不充分，应提出具体的治疗方案。全身性激素替代疗法对夜尿症有有益的效果，不会影响夜间多尿症患者的钠和水清除。据推测，激素治疗改善夜尿症是由于改善了睡眠障碍。
