What causes menopause urinary symptoms, and what can you do?

Many women are troubled by menopausal urinary symptoms, like needing to pass urine frequently and in the night, burning and stinging, and bladder leaks. It’s due to low estrogen and is often neglected. Here’s why it happens and what you can do about it…

Estrogen profoundly affects the female sexual organs and the lower urinary tract. It might seem odd that estrogen affects the urinary tract, but it’s because the sexual organs and lower urinary tract develop from the same tissues in the embryo. It’s this common origin that leads to urinary symptoms in menopause.

The genitourinary syndrome of menopause

The effects on the urinary tract are what cause menopausal urinary symptoms, typically:

• You need to pass urine frequently
• The need to pee often disturbs your sleep
• It can burn or sting when you pass urine
• The urge can come suddenly, and sometimes you may not reach the toilet in time. Around two-thirds of postmenopausal women report bladder leaks at least once a month

Because the lining of the bladder and urethra isn’t as healthy as before, you’ll be more susceptible to urinary tract infections. Since infections cause the same symptoms, it’s worth getting your urine checked.

Although very many women experience these symptoms, they’re not talked about in the same way as hot flashes and brain fog. That means many women don’t know they’re menopause-related and don’t ask for treatment. Only 40% of women with GSM take any treatment; even then, it’s usually an over-the-counter product.

What can you do about the urinary symptoms of menopause?

First, it’s worth ensuring your symptoms are all down to GSM. Ask your doctor to check your urine to be sure it’s not an infection. You can get similar symptoms with a vaginal infection or from skin irritation. Many things can irritate sensitive skin, including perfumes, powders, soap, deodorant, panty liners, douches, hot tub and pool additives, and tight-fitting or synthetic clothing.

Caffeine, alcohol and fizzy drinks can irritate the bladder and lead to a sensation of urgency. If urgency is a problem, you may want to cut these out and see if it helps.

Getting up to pee at night is just another contributor to disturbed sleep. Limit how much you drink in the evening, so you are less likely to need to go in the night.

Hormone replacement therapy

Whilst HRT is great for many menopausal symptoms, the concentration of estrogen in the urinary tract and sexual organs is low. As a result, HRT isn’t very good at treating GSM. In studies, up to three-quarters of women still had their GSM symptoms after a year of HRT. HRT can also worsen incontinence.

Duavee® is a combination of estrogen with bazedoxifene. The estrogen treats the hot flashes or other symptoms, whilst the bazedoxifene treats the GSM.

Vaginal estrogen

The way to get good estrogen levels in the urinary tract and sex organs is by delivering it directly using pessaries/tablets, creams or as a vaginal ring. It reduces trips to the bathroom and the feeling of urgency, and urinary tract infections are less common.

An alternative to vaginal estrogen is prasterone (Intrarosa®).

Ospemifene

Ospemifene is marketed as Senshio® and Osphena®. Although it’s not estrogen, it has estrogen-like effects on the sex organs and urinary tract when taken by mouth and is an effective treatment for GSM

Dealing with bladder leaks

Half of all women are dealing with bladder leaks by the time they reach menopause. Frustratingly, HRT, which improves many menopausal symptoms, can make incontinence worse.

It is essential to keep active. Sitting down all day does nothing to maintain the tone of pelvic floor muscles, so they become weak. Staying active and exercising regularly brings countless benefits. Preventing bladder leaks is one more benefit. Pelvic floor exercises are especially helpful and should ideally be part of a daily routine.

Maintaining a healthy weight will also help to prevent incontinence. If you’re overweight, you’re up to five times more likely to suffer bladder leaks.

Absorbent pads and underwear can help with the occasional leak or while waiting for treatment, but you should not have to rely on them long-term. Follow the advice here, and if you are troubled by more than trivial bladder leaks, you should talk with your doctor.

Vaginal estrogen can be effective at reducing bladder leaks. A variety of medicines are available for urge incontinence that reduces the ‘irritability’ of the bladder muscles. Surgical options should be considered for stress incontinence if tit continues to be a problem.

Don’t be part of the silent majority who continue to suffer the urinary consequences of menopause. Plenty of effective treatments are available.