Skip to main content

Hormonal Influences on the Pelvic Floor

  • Chapter

Reproductive hormones, especially estrogen, have a significant impact on pelvic floor function. Hormonal changes that occur during a woman's lifespan impact many aspects of female physiology.With the onset of menopause, it becomes evident that estrogen sensitivity is greatest in the central nervous system and the genital tissues.The most frequently occurring initial symptoms of estrogen deprivation include hot flushes,mood changes, and emotional irritability. These central nervous system symptoms are promptly reversible with systemic estrogen replacement. More prolonged duration of estrogen deprivation will lead to other known consequences such as osteoporosis and urogenital atrophy. It is estimated that 80% of postmenopausal women have hot flushes, and that not all women will develop osteoporosis. However, urogenital atrophy occurs universally. Interestingly, many women with urogenital atrophy are asymptomatic. Many treatments are currently available for prevention of and therapy for loss of bone mineral content. However, local estrogen therapy is the only means of treating symptoms and signs of urogenital atrophy.

As related to the pelvic floor, urogenital atrophy is present at both ends of the reproductive cycle, and consequences such as labial fusion may be present both preme-narchally as well as postmenopausally. After the onset of menopause, hypoestrogenism is expressed in the lower genitourinary tract by thinning of the vaginal and urethral mucosa, as well as other well-recognized changes (Table 11-1.1). Estrogen receptors have been found in most body tissues. The presence of estrogen receptors in the pelvic floor mucosa has been demonstrated, as has the importance of the estrogen-replete state in physiologic cellular proliferation. The implications of the lack of estrogen on urogenital well-being will be discussed in this chapter.


  • Pelvic Floor
  • Stress Urinary Incontinence
  • Vaginal Mucosa
  • Estrogen Deprivation
  • Vaginal Atrophy

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-84800-348-4_50
  • Chapter length: 5 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   129.00
Price excludes VAT (USA)
  • ISBN: 978-1-84800-348-4
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   169.99
Price excludes VAT (USA)


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Davila GW, Singh A, Karapanagiotou I, et al. Are women with uro-genital atrophy symptomatic? Am J Obstet Gynecol 2003;188:382–388.

    CrossRef  PubMed  Google Scholar 

  2. Blakeman PJ, Hilton P, Bulmer JN. Cellular proliferation in the female lower urinary tract with reference to oestrogen status. Br J Obstet Gynecol 2001;108:813–816.

    CrossRef  CAS  Google Scholar 

  3. Smith P, Heimer G, Norgren A, Ulmsten U. Steroid hormone receptors in pelvic muscles and ligaments in women. Gynecol Obstet Invest 1990;30:27–30.

    CrossRef  PubMed  CAS  Google Scholar 

  4. Hulley S, Furberg C, Barrett-Connor E, et al. Noncardiovascular disease outcomes during 6.8 years of hormone therapy: heart and estrogen/ progestin replacement study follow-up (HERS II).JAMA 2002;288:58–66.

    CrossRef  PubMed  CAS  Google Scholar 

  5. Handa VL, Bachus KE, Johnston WW, Robboy SJ, Hammond CB. Vaginal administration of low-dose conjugated estrogens: systemic absorption and effects on the endometrium. Obstet Gynecol 1994; 84:215–218.

    PubMed  CAS  Google Scholar 

  6. Bhatia NN, Bergman A, Karram MM. Effects of estrogen on urethral function in women with urinary incontinence. Am J Obstet Gynecol 1989;160:176–181.

    PubMed  CAS  Google Scholar 

  7. Hilton P, Stanton SL. The use of intravaginal oestrogen cream in genuine stress incontinence. Br J Obstet Gynecol 1983;90:940–944.

    CAS  Google Scholar 

  8. Haadem K, Ling L, Ferno M, Graffner H. Estrogen receptors in the external anal sphincter. Am J Obstet Gynecol 1991;164:609–610.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2008 Springer-Verlag London Limited

About this chapter

Cite this chapter

Davila, G.W. (2008). Hormonal Influences on the Pelvic Floor. In: Davila, G.W., Ghoniem, G.M., Wexner, S.D. (eds) Pelvic Floor Dysfunction. Springer, London.

Download citation

  • DOI:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84800-347-7

  • Online ISBN: 978-1-84800-348-4

  • eBook Packages: MedicineMedicine (R0)