Pathogenesis (disease development)
The cause is estrogen deficiency. Estrogen receptors are reduced, atrophy occurs, and loss of function of the external genitalia, vagina, bladder, urethra, and pelvic floor develops; urogenital menopause syndrome develops.
- Most pronounced and regular, these changes occur during the climacteric/menopause (the time of the last menstrual period).
- Less pronounced in the puerperium
- Moderate in hormonal imbalance and cycle disturbances
- Occasionally when taking ovulation inhibitors/antibaby pill
Specifically:
- Vagina (vagina) → atrophic colpitis (vaginitis), colpitis senilis (dry vagina):
- Epithelium: breakdown of the epithelium, which consists of only a few cell layers and no longer forms glycogen.
- Lamina propria (layer of connective tissue found under epithelia):
- Loss of
- Formation of elastic and collagen fibers.
- Ability to form tissue fluid
- Supplying capillaries
- Loss of
- Musculature:
- Reduction of the musculature
- Abolition of the vaginal folds (Rugae vaginales).
- Sheath wall:
- It is pale, thin, as if transparent, reddened, dry, inelastic, vulnerable, often with petechiae.
- Vulva (set of external primary sexual organs) → atrophic vulvitis (inflammation of the external female genital area and vaginal entrance):
- Volume reduction of the labia majora, labia minora, and clitoris (reduction of fat deposits and connective tissue).
- Bladder → atrophic cystitis (cystitis):
- Regression of the mucous membranes and muscles with loss of function.
- Sensory disturbances of bladder emptying → recurrent urinary tract infections, pollakiuria (frequent urination), urge symptoms, urinary incontinence (bladder weakness).
- Urethral → atrophic urethritis (inflammation of the urethra):
- Regression
- Of the mucosa (mucous membrane)
- Reduction of tissue fluid
- Of elasticity
- Of the capillary supply
- Of the venous plexus
- Of the mucosa (mucous membrane)
- Regression of the musculature
- Reduction of anatomical and functional lengthConsequence: favoring ascending infections, insufficiency of urethral closure pressure, reduction of urethral closure pressure.
- Regression
- Pelvic floor:
- Reduction of blood flow, degradation of connective tissue and muscle → pelvic floor insufficiency.
Etiology (causes)
Biographical causes
- Genetic diseases
- Turner syndrome (synonyms: Ullrich-Turner syndrome, UTS) – genetic disorder that usually occurs sporadically; girls/women with this disorder have only one functional X chromosome instead of the usual two (monosomy X); et al. Among other things, with an anomaly of the aortic valve (33% of these patients have an aneurysm/diseased bulging of an artery); it is the only viable monosomy in humans and occurs approximately once in 2,500 female newborns.
- Age of life – climacteric, postmenopause (period that begins when menstruation has ceased for at least a year), senium (old age).
- Hormonal factors – estrogen deficiency situations.
Behavioral causes
Consumption of stimulants
- Tobacco (smoking) – premature menopause (before the age of 45; about 5-10% of women) is dose-dependent in smokers in terms of nicotine abuse.
Medication
- Ovulation inhibitors (birth control pills)
Operations
- Ovarectomy (removal of the ovaries)
X-rays
- Radiatio (radiotherapy) of the ovaries in the context of malignant diseases.
Medication
- Especially in chemotherapies of gynecological carcinomas z.B. Endometrial carcinoma (uterine cancer), mammary carcinoma (breast cancer), ovarian carcinoma (ovarian cancer), vaginal carcinoma (vaginal cancer), vulvar carcinoma (vulvar cancer).