Sex hormones have a substantial influence on the female lower urinary tract (LUT) throughout adult life. Estrogen deficiency, particularly when prolonged, is associated with a wide range of urogenital complaints, including frequency, nocturia, incontinence, urinary tract infections and the urge syndrome. Estrogen therapy may be of benefit for the irritative symptoms of urinary urgency, frequency, and urge urinary incontinence. This effect may result from reversal of urogenital atrophy and not a direct action on the lower urinary tract. Treatment with local estrogen cream seems to have an overall beneficial effect on the severity of SUI.
Role of estrogen in urogenital atrophy is well established. Low-dose, vaginally administered estrogens have an important role in the treatment of urogenital atrophy in postmenopausal women and appear to be as effective as systemic preparations. The newer estriol and estradiol-containing vaginal hormone therapies are safe for short-term use. The vaginal delivery of estrogen causes enhancement of the efficacy of treatment of urogenital symptoms and avoids the need for daily dosage of systemic hormone replacement therapy (HRT). Estrogen replacement therapy may be efficacious in the treatment of women with recurrent lower urinary tract infections.