The Mysteries of Menopause and Urogynecologic Health

Clinical and Scientific Gaps

Marianna Alperin, MD, MS; Lindsey Burnett, PhD, MD; Emily Lukacz, MD, MAS; Linda Brubaker, MD, MS


Menopause. 2019;26(1):103-111. 

In This Article


The etiology of PFDs is related to decline in structural, functional, and regenerative capabilities of the integral components of the female pelvic floor and continence mechanisms. A substantial body of epidemiological literature suggests an association between menopause, and PFDs and rUTIs; however, the inability to separate this association from aging and comorbid conditions makes it difficult to draw definitive conclusions on the role of menopause alone in the development and/or progression of PFDs. Similarly, the causative link between the decline in endogenous estrogen and the pathogenesis of PFDs and rUTIs has not been well-established. As nearly all human studies are limited by the collinearity of menopause and aging, investigations conducted in various experimental models are essential to decipher the mechanisms by which target tissues are affected by variable systemic and local estrogen levels. The existing disconnect between the basic science and clinical observations suggests that estrogen is important, but may not be sufficient for the desired therapeutic effects. Innovative human studies, focused on the independent effects of menopausal estrogen levels, uncoupled from tissue and cellular senescence, are needed. Such investigations have a high potential for bridging the laboratory and clinical findings and for providing a scientific rationale for estrogen replacement regiments ± adjuvant therapies aimed at counteracting PFDs and rUTIs, which significantly interfere with well-being of menopausal women.