The impact of midlife hormonal treatment on lower urinary tract symptoms

Women in midlife are increasingly interested in receiving menopausal hormone therapy (MHT) for symptom relief. Increased patient interest and MHT prescribing require a clinical understanding of the effect of hormonal treatment on lower urinary tract symptoms (LUTS), which often develop in midlife and worsen with age. This review summarizes the divergent LUTS effects conferred by hormone type and mode of delivery.

Vaginal estrogen is well established to help alleviate LUTS, and recent data suggest that periurethral application is noninferior to intravaginal application. Many studies have shown that systemic estrogen results in new and worsening LUTS, and recent studies have begun to probe this opposing effect. Selective estrogen receptor modulators are less well studied but seem to have a less deleterious effect on LUTS than MHT.

The mechanism of the divergent effects of estrogen on LUTS by route of administration remains unclear, but further research may help provide more individualized hormone therapy options for women in midlife experiencing systemic and/or LUTS.