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Background Electroacupuncture has been used for treatment in patients with overactive bladder. This study was conducted to evaluate the efficacy and safety of electroacupuncture for treating overactive bladder of postmenopausal women. Methods/design This is a multicenter, randomized controlled, parallel clinical trial. Two hundred ninety participants with overactive bladder syndrome will be recruited from Dongguk University Bundang Oriental Hospital and Cheonan Korean Medicine Hospital of Daejeon University and randomly allocated into one of two groups in a 1:1 ratio. One group will receive electroacupuncture (EA) and the other acupuncture (AC). The allocation will be concealed from both participants and assessors. The study period will be about 10 weeks, including 6 weeks of electroacupuncture or acupuncture treatment and a four week follow-up period. Both EA group and AT group will undergo acupuncture at 7 fixed points, and the EA group will undergo electronic stimulation at 6 points. The primary outcome will be the average number of micturitions per 24 h based on a 3-day bladder diary. The secondary outcome will comprise the 3-day bladder diary, the overactive bladder symptom score and the results of the King’s health questionnaire. Discussion The results of this trial will provide information regarding the efficacy and safety of electroacupuncture for treating overactive bladder in postmenopausal women. Trial registration ClinicalTrials.gov, NCT03260907 . Registered on 24 August 2017.

Postmenopausal women who have ovary hormone deficiency (OHD) may experience urological dysfunctions, such as overactive bladder (OAB) symptoms. This study used a female Sprague Dawley rat model that underwent bilateral ovariectomy (OVX) to simulate post-menopause in humans. The rats were treated with platelet-rich plasma (PRP) or platelet-poor plasma (PPP) after 12 months of OVX to investigate the therapeutic effects of PRP on OHD-induced OAB. The OVX-treated rats exhibited a decrease in the expression of urothelial barrier-associated proteins, altered hyaluronic acid (hyaluronan; HA) production, and exacerbated bladder pathological damage and interstitial fibrosis through NFƘB/COX-2 signaling pathways, which may contribute to OAB. In contrast, PRP instillation for four weeks regulated the inflammatory fibrotic biosynthesis, promoted cell proliferation and matrix synthesis of stroma, enhanced mucosal regeneration, and improved urothelial mucosa to alleviate OHD-induced bladder hyperactivity. PRP could release growth factors to promote angiogenic potential for bladder repair through laminin/integrin-α6 and VEGF/VEGF receptor signaling pathways in the pathogenesis of OHD-induced OAB. Furthermore, PRP enhanced the expression of HA receptors and hyaluronan synthases (HAS) enzymes, reduced hyaluronidases (HYALs), modulated the fibroblast-myofibroblast transition, and increased angiogenesis and matrix synthesis via the PI3K/AKT/m-TOR pathway, resulting in bladder remodeling and regeneration.

This study explores low-intensity extracorporeal shock wave therapy (LiESWT)’s efficacy in alleviating detrusor hyperactivity with impaired contractility (DHIC) induced by ovarian hormone deficiency (OHD) in ovariectomized rats. The rats were categorized into the following four groups: sham group; OVX group, subjected to bilateral ovariectomy (OVX) for 12 months to induce OHD; OVX + SW4 group, underwent OHD for 12 months followed by 4 weeks of weekly LiESWT; and OVX + SW8 group, underwent OHD for 12 months followed by 8 weeks of weekly LiESWT. Cystometrogram studies and voiding behavior tracing were used to identify the symptoms of DHIC. Muscle strip contractility was evaluated through electrical-field, carbachol, ATP, and KCl stimulations. Western blot and immunofluorescence analyses were performed to assess the expressions of various markers related to bladder dysfunction. The OVX rats exhibited significant bladder deterioration and overactivity, alleviated by LiESWT. LiESWT modified transient receptor potential vanilloid (TRPV) channel expression, regulating calcium concentration and enhancing bladder capacity. It also elevated endoplasmic reticulum (ER) stress proteins, influencing ER-related Ca2+ channels and receptors to modulate detrusor muscle contractility. OHD after 12 months led to neuronal degeneration and reduced TRPV1 and TRPV4 channel activation. LiESWT demonstrated potential in enhancing angiogenic remodeling, neurogenesis, and receptor response, ameliorating DHIC via TRPV channels and cellular signaling in the OHD-induced DHIC rat model.

Postmenopausal women are at risk of developing an overactive bladder (OAB). Conventional vaginal estrogen has shown promise for symptom relief. Isoflavones have proven effective as an alternative to estrogen treatment against menopause-related symptoms. However, its effect on OAB symptoms has not been studied. This study investigates if fermented red clover isoflavones reduce OAB symptoms in postmenopausal women. In this randomized, double-blinded, placebo-controlled trial, women were administered red clover extract (RCE) or a placebo twice daily for three months. Women filled out the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Urinary Incontinence Short Form (ICIQ-UI-SF), together with a fluid intake and voiding diary. A total of 33 women (16 in the RCE group and 17 in the placebo group) were included in the analysis. Baseline demographics and OAB characteristics were comparable across groups. Intake of RCE did not lead to significant relief in most urinary bladder symptom measures, although a significant reduction in the bother of urinary urgency (p = 0.033) and a tendency towards a decreased ICIQ-OAB score were observed (p = 0.056). In contrast, the placebo exhibited a significant decrease in the ICIQ-OAB score (p = 0.021) and in some diary outcomes. We found that an intake of isoflavones did not relieve OAB symptoms in postmenopausal women.

Background and Objectives: This study examined the utility of local estrogen therapy for improving urinary symptoms in women diagnosed with Overactive Bladder allied to the time of onset of urinary symptoms whether pre- or post-menopausal. Materials and Methods: Subject to informed consent, menopausal women diagnosed with Overactive Bladder (OAB) and Genitourinary Syndrome of Menopause (GSM) were enrolled at three urogynecological units. OAB symptoms were scored using the Global Pelvic Floor Symptoms Bother Questionnaire (GPFSBQ), with explicit attention to question number 3 that specifically addresses the presence or absence of urgency and the Patient Perception of Intensity of Urgency Scale (PPIUS). The Vaginal Health Index (VHI) was used to assess the vaginal mucosa trophism. Exclusion criteria included: Pelvic organ prolapse (POP) ≥ stage II, urinary tract infection or disease, diabetes, inflammatory diseases, use of diuretics, alcohol or drug addictions, neurological and/or psychiatric disorders, and other precluding conditions. Women were treated with local estrogens for 3 months and re-evaluated. Results: Forty-three post-menopausal women were enrolled. Of these, ten women developed OAB symptoms before menopause (Group I) and 33 developed symptoms after menopause (Group II). Following local estrogen therapy, based on the Global Pelvic Floor Symptoms Bother Questionnaire, improvement of OAB symptoms was reported by 20% of patients in Group I (p = 0.414) and 64% of patients in Group II, (p = 0.002). Based on the PPIUS scale, diminution in urinary urgency was experienced by 20% of patients in Group I (p = 0.68) and 66% of patients in Group II (p = 0.036). Improved VHI scores were graded statisticaly significant in both groups (Group I in 100% of women, p = 0.005 vs. 76% in Group II, p = 0.004). Conclusions: Our results indicate that local estrogen therapy is more effective in women who develop OAB after menopause.

Objective Antimuscarinic therapy is a first-line pharmacological treatment for overactive bladder (OAB), but individual response is highly variable. This study aimed to evaluate the effects of antimuscarinic therapy on symptom severity and quality of life (QoL) and to identify key clinical predictors of treatment response in a prospective cohort. Materials and methods A prospective observational cohort study was conducted at a gynecology outpatient clinic between August 2023 and August 2024. A total of 168 patients diagnosed with OAB who completed one year of antimuscarinic therapy (solifenacin, tolterodine, fesoterodine, or oxybutynin) were included. Disease-specific QoL was assessed using the Incontinence Quality of Life (I-QOL) questionnaire, and symptom severity was measured with the Incontinence Severity Index (ISI) at baseline and after three months. Multiple linear regression analysis was performed to identify independent predictors of changes in I-QOL and ISI scores. Results Antimuscarinic therapy led to significant improvements in both QoL and symptom severity. The mean total I-QOL score increased from 35.42 (± 13.32) to 61.18 (± 15.10) ( p  < 0.001), and the mean ISI score decreased from 10.68 (± 1.59) to 6.69 (± 1.70) ( p  < 0.001). However, regression analysis revealed that the therapeutic response was significantly moderated by specific factors. The experience of moderate to severe side effects, particularly dry mouth and constipation, was the strongest negative predictor of QoL improvement (β = -5.87, p  = 0.001). Furthermore, increasing age (β = -0.028, p  = 0.007), postmenopausal status (β = 0.585, p  = 0.045), and the presence of metabolic comorbidities (diabetes/hypertension) were independently associated with diminished improvement in incontinence severity. Conclusion While effective, the benefit of antimuscarinic therapy in OAB is not uniform and is substantially limited by treatment-related side effects, advanced age, menopausal status, and metabolic comorbidities. These easily identifiable clinical factors should be used to personalize treatment selection, optimize patient counseling, and improve long-term management strategies, moving beyond a one-size-fits-all approach to OAB care.

Overactive bladder (OAB) is a common condition in older women, characterized by urinary urgency, frequency, and nocturia. This study compared the efficacy and safety of thread-embedding acupuncture (TEA) and sham TEA in postmenopausal women with OAB. In this multicenter, randomized, controlled trial, 68 postmenopausal women with OAB were allocated in a 1:1 ratio to receive TEA or sham TEA (manual acupuncture without thread embedding) once weekly for 8 weeks, followed by an 8-week follow up. The primary outcome was the mean daily voiding frequency over 3 days. Secondary outcomes included other bladder diary parameters, the Overactive Bladder Symptom Score (OABSS), and the King's Health Questionnaire score. At week 8, both groups showed reductions in 24-hour micturition frequency; however, after adjustment for baseline values using ANCOVA, no significant between-group difference was observed in the primary outcome. Repeated measures analysis demonstrated no significant group-by-time interactions for secondary outcomes, although significant improvements over time were observed in both groups. At follow-up, nighttime voiding remained significantly reduced from baseline in the TEA group, whereas this reduction was not statistically significant in the sham group; however, the between-group difference did not reach statistical significance. No serious adverse events were reported. TEA and manual acupuncture were effective and safe in reducing OAB symptoms in postmenopausal women, with no significant differences between interventions. Larger, long-term studies are needed to clarify specific benefits of TEA.

As estrogen level decreases with aging, the vaginal mucosa gets thinner, and collagen amount decreases. In addition, the population of Lactobacillus in the vagina declines, increasing the risk of atrophic vaginitis, bacterial vaginosis, and genitourinary symptoms in the postmenopausal women. In this study, we evaluated the effects of Lactobacillus -containing feminine hygiene products on vaginal microbiome and genitourinary symptoms in pre- and postmenopausal women. This was a pilot randomized controlled trial in 35 premenopausal and 35 postmenopausal healthy women. For 4 weeks, treatment 1 group (14 premenopausal and 16 postmenopausal women) used the Lactobacillus-containing feminine soap and cream, and treatment 2 group (15 premenopausal and 14 postmenopausal women) used Lactobacillus-containing feminine gel in addition to soap and cream. The remaining 6 premenopausal and 5 postmenopausal women served as controls without using any products. We then compared the changes in the vaginal microbiota, genitourinary symptoms, and other related biomarkers after completion of treatment. Vaginal pH and pathogenic flora were reduced in both treatment groups compared to control group, which was more significant in the treatment 2 group of postmenopausal women. Genitourinary symptoms significantly improved in 60% of premenopausal women in treatment 1 group and 81.3% of postmenopausal women in treatment 2 group, compared to control group (0%, p = 0.043 and p<0.01 respectively). Overactive bladder symptom scores were significantly improved after using the products in eleven out of twelve postmenopausal women suspected of having overactive bladder. The use of Lactobacillus-containing feminine products was associated with improved vaginal ecosystem and urogenital health compared to control group, especially in those women using feminine gel.

Overactive bladder is a major public health concern that negatively impacts a patient's quality of life, and it is highly prevalent in menopausal women. Acupuncture has been suggested as a viable therapeutic approach. This study aimed to explore the effectiveness of thread-embedding acupuncture in postmenopausal women with overactive bladder. This was a single-centre, single-arm, open-label study conducted on 20 postmenopausal women with overactive bladder. Participants received thread-embedding acupuncture treatment once a week for 8 weeks. Patients were evaluated using a bladder diary, overactive bladder symptom score (OABSS), and King's Health Questionnaire (KHQ) at three time points: baseline, end of treatment (week 8), and 4 weeks after treatment completion (week 12). Nineteen participants completed the study. Average daily micturition frequency decreased significantly after thread-embedding acupuncture treatment (week 8: -2.55 ± 0.37,  =0.001, week 12: -2.69 ± 0.37, =0.001). Daytime and nighttime micturition frequency and OABSS significantly decreased at week 8 and 12. However, no significant differences were observed in urgency, incontinence, or KHQ. No serious adverse events were reported. Considering that thread-embedding acupuncture was shown to improve daily quality of life by reducing daytime and nighttime episodes, this pilot study suggests that thread-embedding acupuncture is a feasible alternative for treating overactive bladder.

Objectives: Equol, a gut-derived metabolite of soy isoflavones with estrogenic activity, may influence bladder aging. However, the association between overactive bladder (OAB), which is closely linked to bladder aging, and the estrogenic effects of equol remains unknown. Therefore, this study investigated the association between endogenous equol production and onset and severity of OAB in postmenopausal women. Methods: The study included 128 postmenopausal women, newly diagnosed with OAB, who were categorized into equol- and non-equol-producing groups based on urinary equol levels as measured by enzyme-linked immunosorbent assay. Patient clinical characteristics, OAB Symptom Score (OABSS), and urodynamic parameters were assessed. Propensity score matching was performed to minimize confounding factors related to the timing of lower urinary tract symptom (LUTS) onset. Results: Equol producers exhibited a significantly later onset of LUTS than non-producers (68.7 ± 10.9 vs. 62.7 ± 10.7 years, p = 0.002). Equol producers were more prevalent in the late-onset group (58.6% vs. 31.0%, p = 0.002), which had significantly higher urinary equol concentrations than the early-onset group (p = 0.014). No significant differences were observed in total OABSS or subscale scores between the groups, suggesting that equol did not affect symptom severity. Propensity score-matched analysis (n = 104) confirmed that equol non-production was an independent risk factor for early-onset LUTS (OR, 1.930; 95% CI, 1.248–4.049; p = 0.014). Conclusions: Endogenous equol production was significantly associated with the delayed onset of OAB in postmenopausal women. Thus, equol may serve as a protective factor and non-invasive biomarker to guide individualized prevention and early intervention strategies in urological care for women.