The similar atrophic changes that occur in the urethral epithelium are called atrophic urethritis. Loss of estrogens may also affect the muscles that help maintain continence. Suprapubic pain can occur, even without infection, possibly because the markedly thin urethral mucosa may allow urine to come in close contact with sensory nerves. For about 10 years after menopause, bone loss accelerates by as much as tenfold. It is six times more common among women than among men.
Osteoporosis leads to fractures.
Estrogens may also protect against atherosclerosis by promoting vasodilation, preventing platelet aggregation, reducing smooth muscle proliferation, slowing lipoprotein oxidation, and lowering plasma homocysteine levels. Diagnosis Menopause can usually be diagnosed clinically. The diagnosis may be confirmed by an elevated level of serum follicle-stimulating hormone. A low level of serum estradiol is not diagnostic, because levels are often low during menses. A history and physical examination should be sufficient to diagnose hot flashes and exclude other disorders, such as thyrotoxicosis, carcinoid, and pheochromocytoma, that produce similar symptoms.