Common Reproductive Conditions Uroatrophy is an inflammation of the vagina (and the outer urinary tract) due to the thinning

and shrinking of the tissues, as well as decreased lubrication. This is all due to a lack of the reproductive hormone estrogen. Other Names: o urogenital atrophy o vaginal atrophy o atrophic vaginitis Causes: Vaginal atrophy is caused by a decrease in estrogen production. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile. A drop in estrogen levels and vaginal atrophy may occur:

Perimenopause, Menopause, Postmenopause when normal, age-related body changes cause the ovaries to decrease their production of estrogen. Estrogen levels begin to fall as the menopause approaches Prior to menopause, the vaginal lining appears plump, bright red, and moist. As estrogen levels decline, the lining of the vagina becomes thinner, drier, light pink to bluish in color, and less elastic. This is a normal change that is noticed by many perimenopausal and postmenopausal women.

Premature menopause, which occurs before age 40, a younger age than is considered normal for the average woman. Most women reach menopause between the ages of 45 and 55, but it can occur earlier or later in life. The average age of menopause is 51 years old. Every woman is different, and there is no definitive way to predict when an individual woman will enter menopause. During breast-feeding incd prolactin concentrations -Functionally and very simply, the hormones Estrogen and Prolactin oppose each other. When one is high it suppresses the other. These two hormones are like a Seesaw, one goes up, the other goes down. Not only this, the Seesaw prefers to have one or the other end down rather than to be balanced in the middle with both hormones equal. In the normal non-pregnant state the Seesaw is balanced with high Estrogen and low Prolactin. To get this Seesaw to tip the opposite way requires much nipple stimulation. Once it is tipped the other way it usually requires less effort to keep it tipped toward Prolactin because the breasts increase their sensitivity and response to stimulation and put out much more Prolactin with stimulation. The greatest sign that the Seesaw is tipped fully toward Prolactin is when the woman stops menstruating. When this occurs it means the ovaries are quiet and not putting out Estrogen in the normal monthly cyclic pattern.

The post-partum state begins when the woman delivers the baby and placenta. The placenta is the source of all the high hormone levels during pregnancy. The ovaries are quiet because the FSH (follicle stimulating hormone) that turns them on has been absent. As she enters this low Estrogen state the sensitivity for Prolactin release is turned on. Her Seesaw is tipped fully toward Prolactin. If she breastfeeds frequently enough, the FSH signal will be suppressed, Estrogen will stay low, she will not menstruate and her breasts will produce copious amounts of milk. This condition can last for as little as a month or so to a year or more. When the breastfeeding frequency and nipple stimulation decreases, typically when the infant is being weaned, her menstrual cycle will return and she becomes fertile again. This indicates that FSH suppression is not complete because the interval between breastfeeding events has increased to the point that the FSH signal is escaping and intermittently stimulating the ovaries. When the FSH signal becomes strong and regular enough, her Estrogen level will rise enough to cause her breasts to dry up. The Seesaw has tipped back toward high Estrogen.

After surgical removal of both ovaries (oophorectomy) Estrogens are mainly produced by the ovaries. After pelvic radiation therapy for cancer - Radiation therapy can directly produce changes in vaginal mucosa, fibrosis, and vaginal stenosis from the trauma of radium applicators, direct radiation effects, and radiation castration. Premature ovarian failure After chemotherapy for cancer - Premature ovarian failure As a side effect of breast cancer hormonal treatment drugs these drugs suppress production of estrogen in the body anti estrogen therapy Smoking. Cigarette smoking impairs blood circulation, depriving the vagina and other tissues of oxygen. Decreased blood flow to your vagina contributes to atrophic changes. Smoking also reduces the effects of naturally occurring estrogens in the body. In addition, women who smoke have an earlier menopause and are less responsive to estrogen therapy in pill form. Symptoms Common signs of vaginal atrophy include:

Vaginal dryness Vaginal itch or a burning sensation Painful sexual intercourse Light bleeding after intercourse Burning with urination Urgency with urination More urinary tract infections Urinary incontinence

Shortening and tightening of the vaginal canal Complications With vaginal atrophy, your risk of vaginal infections (vaginitis) increases. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection with bacteria, yeast or other organisms. Atrophic vaginal changes are associated with changes in your urinary system (genitourinary atrophy), which can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or incontinence. Tests and diagnosis Diagnosis of vaginal dryness may involve:

Pelvic exam. Your doctor visually inspects your external genitalia, vagina and cervix and inserts gloved fingers into your vagina to feel (palpate) your pelvic organs for signs of disease. Pap test. Your doctor collects a sample of cervical cells for microscopic examination. He or she may also take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to estrogen deficiency. Urine test. You provide a urine sample to be analyzed for urinary conditions, if you have associated urinary symptoms. Treatments and drugs By Mayo Clinic staff Mild symptoms of vaginal atrophy may be relieved by use of an over-the-counter lubricant or moisturizer. If symptoms are bothersome, however, either topical (vaginal) or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen may also provide more direct relief of symptoms. You should experience noticeable improvements after a few weeks of estrogen therapy. Some symptoms of severe atrophy may take longer to resolve.

If you have a history of breast cancer, oral estrogen therapy generally isn't recommended as it might stimulate cancer cell growth, especially if your breast cancer was hormonally sensitive. You might choose nonhormonal treatments, such as moisturizers and lubricants, instead. Topical estrogen Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can determine which one is best suited to your preferences.

Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily application for the first few weeks and then two or three times a week thereafter. Although creams may offer more immediate relief than do other forms of vaginal estrogen, they can be more messy.

Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Many women like the convenience this offers. Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet; you might, for instance, use it daily for the first two weeks and then twice a week thereafter. Oral estrogen therapy If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring along with a progestin. Progestin is usually given as a pill, but combination estrogen-progestin patches also are available. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.

*** With estrogen loss, the bladder and urethra also can become atrophic, causing urinary frequency and incontinence. After menopause, estrogen (estradiol) production drops significantly.Vaginal tissue is highly estrogen sensitive. During the reproductive years, estrogen matures the vaginal tissue, making it thicker. During menopause and postmenopause diminished estrogen results in thinning of the vaginal and vulvar tissue. The vulva and vagina become more pale in color, drier and more easily injured or irritated by sexual activity. The base of the bladder also has estrogen sensitive tissue. Menopausal tissue changes in the bladder also result in thin, weakened bladder tissue.

These vaginal and bladder changes are referred to as Uro-genital Atrophy. Symptoms are usually mild during the menopause transition, and tend to become more progressive during the postmenopausal years. Symptoms of Atrophic Vaginitis can present as vaginal dryness, vulvovaginal pruritus (itch), vaginal dyspareunia (painful intercourse) & postcoital spotting (lite bleeding after sexual activity). Symptoms of Atropic Urethritis and recurrent cystitis (inflammation of the urinary bladder) can present as dysuria (difficult or painful urination), frequency and incontinence (inability to control urination).

Prevention A water-soluble vaginal lubricant can be used to moisten the tissues and prevent painful sexual intercourse. Regular sexual activity also can help to prevent symptoms. This is because sexual intercourse improves blood circulation to the vagina, which helps to maintain vaginal tissue and helps to keep the tissues supple.
While estrogens are present in both men and women, they are usually present at significantly higher levels in women of reproductive age. They promote the development of female secondary sexual characteristics, such as breasts, and are also involved in the thickening of the endometrium and other aspects of regulating the menstrual cycle. In males, estrogen regulates certain functions of the reproductive system important to the maturation of sperm
[10][11][12] [13][14]

and may be necessary for a healthy libido.

Furthermore, there are several

other structural changes induced by estrogen in addition to other functions. Structural Promote formation of female secondary sex characteristics Accelerate metabolism Increase fat stores Stimulate endometrial growth Increase uterine growth Increase vaginal lubrication Thicken the vaginal wall Maintenance of vessel and skin Reduce bone resorption, increase bone formation Reduce muscle mass
[citation needed]

Protein synthesis Increase hepatic production of binding proteins

Coagulation Increase circulating level of factors 2, 7, 9, 10, plasminogen Decrease antithrombin III Increase platelet adhesiveness

Lipid Increase HDL, triglyceride Decrease LDL, fat deposition

Fluid balance Salt (sodium) and water retention Increase cortisol, SHBG

Gastrointestinal tract Reduce bowel motility Increase cholesterol in bile

Melanin Increase pheomelanin, reduce eumelanin

Cancer Support hormone-sensitive breast cancers (see section below)

Lung function Promotes lung function by supporting alveoli (in rodents but probably in humans).
[16 [15]

Sexual desire is dependent on androgen levels rather than estrogen levels.