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After menopause, there are many changes that happen to the genital and urinary systems due to the decrease in available estrogen. - The vagina after menopause narrows and decreases in length. In addition, the labia thins and there is reduced blood flow to the vagina. The lack of estrogen weakens the bladder (which holds urine) and the urethra, the tube that carries urine out of the body, compromising their ability to control urinary functions. Reduced estrogen also alters the acidity of the vulva and the vagina, which can make the area more prone to infection by bacteria or yeast overgrowth. Symptoms related to the urinary system include: Stress incontinence, urge incontinence, increase urinary frequency, and nocturia (waking up at night to urinate). Symptoms related to vaginal atrophy include: vaginal dryness, itching, or burning; pain during intercourse; increased urinary tract infections, vaginal bleeding. Vaginal estrogen is a topical form of estrogen and there is minimal systemic absorption. It helps reverse many of the changes due to menopause.

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