The Connection Between Menopause and OAB

Menopause is the time in a woman’s life when her ovaries stop releasing eggs and menstruation ends. Most women reach menopause by their late forties or early fifties. It’s sometimes referred to as the “change of life.”

Symptoms of overactive bladder (OAB) include:

• increased urinary frequency
• a sudden urge to urinate
• the need to urinate during the night
• difficulty getting to the bathroom without leaking

According to the Urology Care Foundation, women are at greater risk for OAB after menopause. Risk of OAB is also increased following stroke and some neurological diseases like multiple sclerosis (MS).

Estrogen is a female hormone necessary for sexual development in women. Most estrogen is produced in the ovaries. In addition to the sexual and reproductive systems, estrogen affects the health of other organs and body systems, including the pelvic muscles and the urinary tract.

During menopause, estrogen levels drop dramatically. Eventually, the body stops producing estrogen altogether.

For women, the bladder and urethra have hormone receptors. A woman’s steady supply of estrogen helps to preserve the strength and flexibility of supportive pelvic and bladder tissues. Lack of estrogen may be part of the reason these supportive tissues sometimes weaken as a woman ages. Low estrogen levels may also contribute to muscular pressure around the urethra.

According to the National Association for Continence, women suffer urinary incontinence four to five times as often as men. Some of that has to do with pregnancy and childbirth, which can weaken the vagina, the pelvic floor muscles, and the ligaments that support the bladder. This can cause the bladder to be pushed out of place, making it harder for the muscles to perform. That’s why you may leak a little urine when you sneeze, cough, or laugh.

Your doctor will likely recommend a combination of fluid and dietary changes, as well as pelvic floor muscle exercises (Kegel exercises). Many women find success with bladder training, which involves holding off urinating to build longer time intervals, and scheduling urination for specific times. Your doctor may also prescribe medication to relax your bladder. If nothing else works, ask your doctor about surgical options.

Estrogen can improve the flow of blood and strengthen the tissue around the urethra. Low-dose topical estrogen creams or patches are sometimes used to treat overactive bladder in menopausal or post- menopausal women. According to the Mayo Clinic, scientific evidence to support this treatment is lacking. Still, some women say it helps control leaking and the urge to go. Topical estrogen creams may be used together with Kegel exercises for more promising results.  

It takes about three months of treatment for symptoms of incontinence to improve. Unfortunately, symptoms may return within a few weeks after you stop using it. Women who use topical estrogen rarely experience side effects.

Topical estrogen should not be confused with combination hormone replacement therapy (HRT), which involves both estrogen and progestin. HRT may cause side effects and is no longer recommended to treat incontinence.

According to the Urology Care Foundation, about 40 percent of women in the United States experience symptoms of OAB. Although OAB can make it hard to enjoy everyday activities, many women won’t seek help because they’re too embarrassed.

See your doctor if you:

• urinate more than eight times in a 24-hour period
• get up in the night to urinate
• experience frequent leaking
• have changed your activities to accommodate your symptoms

Menopause doesn’t mean you have to live with OAB. The right treatment could change your life.