Editing Menopause (section)

===Vagina, uterus and bladder (urogenital tract)===
[[File:Vaginal_Canal_Normal_vs._Menopause.png|thumb|Size of the [[vaginal canal]] before and after menopause, demonstrating vaginal [[atrophy]]]]
During the transition to menopause, [[Menstrual cycle|menstrual patterns]] can show shorter cycling (by 2–7 days);<ref name="Hoffman20122" /> longer cycles remain possible.<ref name="Hoffman20122" /> There may be [[Irregular menstruation|irregular bleeding]] (lighter, heavier, spotting).<ref name="NIH2013Sym" /><ref name="Hoffman20122" /> [[Dysfunctional uterine bleeding]] is often experienced by women approaching menopause due to the hormonal changes that accompany the menopause transition. Spotting or bleeding may simply be related to vaginal [[atrophy]], a benign sore ([[Polyp (medicine)|polyp]] or lesion), or may be a functional endometrial response. The [[European Menopause and Andropause Society]] has released guidelines for assessment of the [[endometrium]], which is usually the main source of spotting or bleeding.<ref name="pmid236190092">{{cite journal |vauthors=Dreisler E, Poulsen LG, Antonsen SL, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Pérez-López FR, Simoncini T, Tremollieres F, Rees M, Ulrich LG |date=June 2013 |title=EMAS clinical guide: assessment of the endometrium in peri and postmenopausal women |journal=Maturitas |volume=75 |issue=2 |pages=181–90 |doi=10.1016/j.maturitas.2013.03.011 |pmid=23619009}}</ref>

In post-menopausal women, however, any unscheduled vaginal [[bleeding]] is of concern and requires an appropriate investigation to rule out the possibility of malignant diseases.

Urogenital symptoms may appear during menopause and continue through [[postmenopause]] and include [[Dyspareunia|painful intercourse]], [[vaginal dryness]] and [[atrophic vaginitis]] (thinning of the membranes of the [[vulva]], the [[vagina]], the [[cervix]] and the outer [[urinary tract]]). There may also be considerable shrinking and loss in elasticity of all of the outer and inner genital areas. [[Urinary urgency]] may also occur and [[urinary incontinence]] in some women.<ref name="Hoffman20122" /><ref name=":4">{{Cite journal |last1=Allafi |first1=Ahmad Hasan |last2=Al-Johani |first2=Amal Saleem |last3=Babukur |first3=Raed M. |last4=Fikri |first4=Jehad |last5=Alanazi |first5=Raneem Rashed |last6=Ali |first6=Sara Dafaalla Mohamed Hag |last7=Alkathiry |first7=Abdulrahman |last8=Alfozan |first8=Abdalmelk Mohmed |last9=Mayoof |first9=Kawthar Ishaq Ahmed Ali Husain |last10=Abualhamael |first10=Maya Ahmad |date=2024 |title=The Link Between Menopause and Urinary Incontinence: A Systematic Review |journal=Cureus |volume=16 |issue=10 |pages=e71260 |doi=10.7759/cureus.71260 |doi-access=free |issn=2168-8184 |pmc=11550778 |pmid=39525118}}</ref>