How does menopause affect the urogenital system?

Updated: Sep 13, 2021
  • Author: Nicole K Banks, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Estrogen plays an important role in maintaining the normal physiology of the urogenital system. Decreased circulating levels of this hormone during menopause are associated with a change in the microenvironment of the urogenital organs. The mucosal lining of the urethra, urinary bladder, vagina, and vulva shows atrophic changes and becomes thinned. The vagina loses its elasticity and distensibility and becomes short and narrow. Normal secretions from the vaginal glands are reduced. The subepithelial vasculature and the supporting subcutaneous connective tissue also demonstrate degenerative changes over time.

As endogenous estrogen levels decrease, so does the production of epithelial-cell glycogen. This alteration changes the normal alkaline milieu of the vagina and bladder. The resultant acidic pH alters the local flora of the vagina and urinary bladder, allowing for their colonization by gram-negative bacteria and fungi and predisposing the woman to recurrent urinary tract infections.

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