Urogenital

The vagina, urethra and bladder trigone are oestrogen dependent and gradually atrophy after the menopause.

Absence of oestrogen results in:

• thinning of the vaginal skin - which may cause severe superficial dyspareunia and bleeding. Many couples may avoid sexual intercourse as a result of the discomfort.
• lack of glycogen - resulting in a rise in vaginal pH - usually from pH 4.0 to pH 7.0 - and increased risk of infection.
• reduced elasticity of the bladder - producing frequency and urgency of micturition, nocturia and dysuria.

These changes are not usually apparent until several years after the menopause. Treatment is with topical oestrogen creams or a short course of oral oestrogen.

Vaginal bleeding after the menopause is an ominous sign and warrants careful investigation. Up to 10% of cases are due to malignancy.