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Nocturia through the menopausal transition and beyond: a narrative review

  • Review Article
  • Published:
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Abstract

Introduction and hypothesis

Nocturia, defined as the act of waking to pass urine during sleeping, is a common problem in older women and is associated with significant morbidity and impairments in health-related quality of life. The aim of this review was to synthesize the current evidence regarding the incidence, impact, pathophysiology, and specific diagnostic approach of nocturia in the postmenopausal population.

Methods

We searched PubMed and Web of Science databases to identify relevant studies published through June 2020. Reference lists of the reviews obtained were screened for other articles deemed pertinent by the authors.

Results

Genitourinary symptoms attributed to the menopause have been reported to occur in nearly 90% of postmenopausal women, and nocturia is one of the most common. The relative deficiency in endogenous estrogen production after the menopause is thought to exacerbate all major pathophysiological mechanisms that may underlie nocturia, including reduced bladder capacity, nocturnal polyuria, global polyuria, and sleep disorders. Diminished estrogen may induce anatomical and physiological bladder changes, contributing to a reduction in functional bladder capacity. Excess nocturnal urine production can also be provoked by estrogen depletion, either via free water-predominant diuresis by an impaired secretion of antidiuretic hormone, or a salt-predominant diuresis owing to diminished activation of the renin–angiotensin–aldosterone axis. Additionally, a relationship between the transition to menopause and impaired sleep has been described, mediated by increased incidence in vasomotor symptoms and obstructive sleep apnea signs during the menopause.

Conclusion

Further research is necessary to better characterize and manage nocturia in postmenopausal women.

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Abbreviations

ADH:

Antidiuretic hormone

BMI:

Body mass index

DM:

Diabetes mellitus

FVC:

Frequency volume chart

FWC:

Free water clearance

MHT:

Menopausal hormone therapy

NP:

Nocturnal polyuria

OAB:

Overactive bladder syndrome

OSAS:

Obstructive sleep apnea syndrome

RAAS:

Renin–angiotensin–aldosterone system

VMS:

Vasomotor symptom

VTE:

Venous thromboembolism

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Acknowledgements

The authors thank the Ghent University Frederik Paulson Chair for unrestricted support.

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Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Kim Pauwaert, Lynn Ghijselings & Karel Everaert

  2. Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Ghent, Belgium

    An-Sofie Goessaert

  3. Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Thomas F. Monaghan

  4. Department of Gynecology, Ghent University Hospital, Ghent, Belgium

    Herman Depypere

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  1. Kim Pauwaert
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Correspondence to Kim Pauwaert.

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K.P. receives a research grant from Ferring; K.E. reports grants and other financial contributions from Ferring, grants from Astellas, grants and other financial contributions from Medtronic outside the submitted work, shareholder and co-founder of P2S. The remaining authors claim no conflicts of interest.

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Pauwaert, K., Goessaert, AS., Ghijselings, L. et al. Nocturia through the menopausal transition and beyond: a narrative review. Int Urogynecol J 32, 1097–1106 (2021). https://doi.org/10.1007/s00192-020-04640-7

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