••• CHAPTER 33^ Menopause^329
❍ Is urinary stress incontinence related to estrogen deficiency?
Yes. Urethral shortening and decreased urethral closing pressures associated with atrophy may contribute to urinary
incontinence.
❍ Can urge incontinence be treated with estrogen therapy?
Yes.
❍ Can estrogen therapy improve urinary stress incontinence?
There is conflicting data, but the best available evidence suggests estrogen therapy is not effective.
❍ What is the best initial therapy for urinary stress incontinence?
Kegel exercises.
❍ What other treatments exist for urinary stress incontinence?
Duloxetine (SNRI), collagen injections, and surgery.
VASOMOTOR AND PSYCHOLOGICAL SYMPTOMS
❍ What is a hot flash?
Sudden onset of warmth and reddening of the skin beginning in the head spreading to the neck and chest,
sometimes concluded by profuse perspiration, lasting a few seconds to several minutes. It is often accompanied by
palpations and feelings of anxiety.
❍ What percentage of women experience hot flashes?
75% to 85%.
❍ What is the physiology of the hot flash?
It originates in the hypothalamus and represents thermoregulatory instability in response to estrogen fluctuation.
❍ How long do hot flashes typically continue?
Typically 1 to 2 years, usually 5 years at most. The incidence of flashes is 80% at 1 year and 20% at 5 years.
❍ What physiologic changes are associated with the hot flash?
An LH surge, an increase in body surface temperature, and skin conductance followed by a decline in core body
temperature.
❍ What’s the frequency of hot flashes?
Usually several times a day. Can range from 1 to 2 daily to 1 per hour.
❍ Are hot flashes more common at night?
Yes.