1. Urogenital symptoms in the postmenopause
Faustino R. Pérez-López
University of Zaragoza Faculty of Medicine and Lozano-Blesa University Hostpital, Zaragoza 50009, Spain
Urogenital symptoms in the postmenopause

2. Learning Objectives
Describe the current evidence-based recommendations for women in their second half of life regarding urogenital symptoms
Review the trends in urogenital symptoms
Describe current approaches for the management of urogenital symptoms
Describe the current evidence-based recommendations for women in their second half of life

3. Outline Genitourinary changes and menopause Nocturia
The genitourinary syndrome
Nocturia
Urinary incontinence
Stress urinary incontinence
Overactive bladder
Vulvovaginal atrophy
Vulvoperineal lichen sclerosous
Vestibulodynia and vulvodynia

4. The Micturition Cycle

5. Diminished ovarian hormones and urogenital effects
The urethra and trigone are estrogen-dependent tissues
Estrogen deficiency can contribute to urinary incontinence and urinary dysfunction.
Reduction in urinary pH which contributes to bacterial flora change that may result in pruritus and maladorous discharge
Vaginal changes that may produce insertional dyspareunia
Atrophic cystitis that can mimic urinary tract infections 5

6. Genitourinary system changes and menopause
Atrophy of vaginal epithelium
Atrophic urethritis and cistitis
Drop in urethral closure pressure at rest and in stress
Descent of the uterus due to decreased collagen in the uterosacral and cardinal ligaments
Pubic hair becomes sparse
Increase in the prevalence of abdominal obesity