Estrogen is a hormone that is present in both men and women, but in significantly higher amounts in women. Its primary function is to stimulate the development of female sexual maturity, namely breast development, pubic hair growth, and the onset of menstruation. Other functions of estrogen include increasing bone growth and reducing bone breakdown, as well as Increasing vaginal lubrication and vaginal tissue thickness.
Estrogen receptors are found throughout the bladder, urethra, vagina, and pelvic floor muscles, and have been found to play an important role in continence, through enhancing urethral resistance and improving the bladder’s ability to store urine.
Did you also know that estrogen affects the cardiovascular system? It helps lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels, facilitates blood clotting, and relaxes blood vessels to increase blood flow. Estrogen also protects women against heart disease.
Finally, estrogen fortifies the urinary system by increasing production of proteins that fight bacteria in the bladder, and by strengthening its lining.
With all the benefits that estrogen provides, it stands to reason that the decline in production which occurs during menopause can have significant effects, and has been thought to contribute to pelvic floor dysfunction. A condition called urogenital atrophy can result in vaginal dryness, irritation, and dyspareunia, or pain with intercourse. In addition, estrogen depletion is thought to have an effect on urinary incontinence and pelvic organ prolapse (POP). For these reasons, estrogen replacement therapy has been touted as an effective treatment. Hormone replacement can be either systemic or local; this post is primarily interested in local hormone applications.
A recent systematic review investigating the effectiveness of local estrogen therapies on vaginal atrophy, incontinence and POP found a statistically significant decrease in physical signs and symptoms of vaginal atrophy, as well as decreased vaginal pH, following local estrogen therapy. No significant difference was found among types of administration (cream vs ring vs suppository vs gel). Treatments incorporating estrogen plus pelvic floor rehabilitation were found to be more beneficial than estrogen alone. The effects of estrogen replacement on overactive bladder symptoms (urinary urgency/frequency, nocturia) were generally positive, and a significant improvement in stress UI was found when estrogen replacement was combined with pelvic floor rehabilitation.
So what does this mean? Estrogen benefits the body in many ways, and its depletion can negatively impact the pelvic floor. Your physician may recommend estrogen replacement therapy to help address your pelvic floor symptoms. In order to maximize the benefit of estrogen therapy, consider combining it with pelvic floor PT. To learn how PT can benefit you, give us a call!
Weber, M. A., Kleijn, M. H., Langendam, M., Limpens, J., Heineman, M. J., & Roovers, J. P. (2015). Local Oestrogen for Pelvic Floor Disorders: A Systematic Review. PloS one, 10(9), e0136265. https://doi.org/10.1371/journal.pone.0136265
Milson, I. (2006). Menopause-related Symptoms and Their Treatment. In R, Erkkola (Ed.), The Menopause. (pp. 9-16).
Holland, K. (2017, April 7). 4 Benefits of Estrogen Therapy. Healthline. Retrieved from https://www.healthline.com/health/womens-health/benefits-of-estrogen.