As a female, you have probably heard the word “estrogen” thrown around quite a bit. But how well do you actually recognize the importance of it, and the role this hormone plays in your body? Estrogen is mainly produced in the ovaries and plays a crucial role for sexual and reproductive development from puberty to menopause. During puberty, estrogen plays a role in the development of secondary female sex characteristics; breasts, wider hips, pubic hair. During menstruation, if the egg is not fertilized then estrogen levels decrease and menses begins. During pregnancy, estrogen plays a role in lactation. However, after menopause, the available estrogen in your body naturally decreases. In addition to estrogen being produced in the ovaries, it can also be produced by fat cells and the adrenal gland. Particularly in postmenopausal women, adipose tissue is the major site of estrogen production. This is why as you age, your body holds on to adipose accumulation around the abdominal area. Despite this, the decrease in produced estrogen, can possibly lead to pelvic floor disorders, effecting mucous membranes, strength and thickness of the vaginal wall, vaginal lubrication and/or causing urinary incontinence, overactive bladder and pelvic organ prolapse. In fact, a decrease in estrogen can increase sensitivity in nerve endings, triggering an urge to void. It can also contribute to a decrease in urethral closure as well as leading to vaginal itching, burning, and stinging pain.
Have you ever heard of estrogen as a topical supplement? A study published in 2015 describes that estrogen has many receptors in the bladder, urethra, vagina and pelvic floor musculature. Numerous studies have researched systemic hormonal replacement, but the focus is now shifted to topical estrogens as this reduces adverse side effects. Topical estrogen can affect continence by enhancing urethral resistance. In addition, estrogen can reduce the frequency and amplitude of bladder contractions, in turn raising the sensory threshold of the bladder. Furthermore, estrogen can change collagen metabolism to premenopausal state, related to pelvic organ prolapse. Topical estrogen can increase the synthesis of collagen improving the strength of vaginal epithelium. A study comparing topical estrogen to placebo showed that women treated with local estrogen experienced less symptoms of vaginal atrophy compared to the placebo group after 12 weeks of treatment. Overall, vaginal estrogen treatment has been proven to be effective and safe for the treatment of vaginal atrophy related symptoms for postmenopausal women with a decline in available estrogen.
References
- Weber MA, Kleijn MH, Langendam M, Limpens J, Heineman MJ and Roovers JP. Local estrogen for pelvic floor disorders: A systematic review. PLoS One.2015;10(9):10.1371/journal.pone.0136265
- Whiteman H. Estrogen may influence location of women’s fat. Website. https://www.medicalnewstoday.com/articles/264146.php. Published July 31, 2013. Accessed July 24, 2019.
- Downey P, Radar H. Pelvic floor function, dysfunction and treatment (Level 1). Vulvodynia. Lecture presented at Herman and Wallace Pelvic Rehabilitation Institute; May 18-20, 2018; Baltimore, MD.