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

Introduction 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.