DOI: 10.1097/01.gco.0000242955.40491.c5

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PMID: 16932047

Issn Print: 1040-872X

Publication Date: 2006/10/01


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Role of hormones in the pathophysiology of pelvic floor disorders in women

Narender N Bhatia; Mat H Ho

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Excerpt

Though the cause of pelvic floor disorders in women tends to be multifactorial, hormones play an important role in the pathogenesis of prolapse or urinary incontinence. The vagina, lower urinary tract, and pelvic organs undergo noticeable changes during menarche, pregnancy, and menopause. Hormonal receptors such as estrogen receptors and progesterone receptors are found in the vagina, urogenital tract, and pelvic floor structures. In postmenopausal women with demonstrable urogenital atrophy, hormone replacement therapy has been shown to improve thickness of vaginal epithelium, vascularity, and possibly reflex urethral function. Earlier studies reported promising results with estrogen therapy for stress urinary incontinence. Recent clinical trials [1], however, have shown that conjugated equine estrogen, alone or in combination with medroxyprogesterone, increases the risks of urinary incontinence among continent women and worsens the characteristics of incontinence among previously symptomatic patients.
Our understanding of the hormonal effects on the lower urinary tract and pelvic support structures in women, particularly at the cellular and molecular levels, is very limited at best. Even precise roles of estrogens and progesterones in these structures are largely unknown. Beside estrogens and progesterones, other hormones such as androgens, relaxin, and growth hormone may also play significant roles in the development or progression of pelvic floor disorders and relaxation defects. These hormones may act directly on the collagen metabolism, cell differentiation, cell proliferation, and cell apoptosis or indirectly through other agents such as nitric oxide synthases and myostatin. The interactions between these hormones and the expressions of hormone receptors in the female pelvic floor may play a significant role in maintaining integrity of the urogenital structures.
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