The signs and symptoms of menopause

Menopause is defined as the final menstrual period a woman experiences. Your doctor will likely suspect menopause if you’ve had 12 straight months of no periods. Once that has occurred, your menstrual cycles by definition have come to an end.

The time leading up to menopause is known as perimenopause. During perimenopause, your body goes through changes in hormone levels. These changes can start several years before your actual menopause and may cause symptoms. After perimenopause is menopause, the end of your period.

Most women reach this phase of life by their late forties or early fifties. The average age of menopause in the U.S. is 51.

Before and during menopause, you may experience certain signs and symptoms, including:

  • a change in your period that differs from your regular cycle
  • hot flashes, or the sudden feeling of heat in the upper part of your body
  • trouble with sleep
  • changing feelings about sex
  • body and mood changes
  • changes with your vagina
  • changes in bladder control

These changes in your bladder control can increase your risk of developing an overactive bladder (OAB). A survey of 351 women in China showed that 7.4 percent had OAB. They also found that women with menopausal symptoms tended to have a higher risk for OAB and symptoms of OAB.

OAB is a term for a collection of symptoms related to bladder control. These symptoms may include:

  • urinating more often
  • experiencing sudden urges to urinate
  • having difficulty getting to a bathroom without leaking urine first
  • needing to urinate two or more times at night

At an older age, these symptoms may increase your risk for falls, especially when you’re rushing to the bathroom. Older age is also associated with osteoporosis, so a fall is often more serious. Research also suggests that older women with OAB and incontinence have an increased risk for disability, poor self-assessment, sleep quality, and overall well-being.

Make an appointment with your doctor if you notice a change in your urinary or bladder symptoms. If you often feel a sudden urge to urinate that’s hard to control, you may have OAB.

Estrogen affects your bladder and urethra

OAB due to menopause may be an effect of changing estrogen levels. Estrogen is the primary female sex hormone. Your ovaries produce most of your estrogen. It’s essential to your sexual health and reproductive system. It also affects the health of other organs and tissues in your body, including your pelvic muscles and urinary tract.

Before menopause, a steady supply of estrogen helps preserve the strength and flexibility of your supportive pelvic and bladder tissues. During perimenopause and menopause, your estrogen levels drop dramatically. This can cause your tissues to weaken. Low estrogen levels may also contribute to muscular pressure around your urethra.

Changes in hormone levels may also increase the risk of urinary tract infections (UTIs) during perimenopause and menopause. UTIs may have similar symptoms as OAB. Talk to your doctor about any new changes to your urinary habits.

Childbirth, trauma, and other causes

Increased age is a common risk factor for pelvic floor disorders, including OAB and urinary incontinence. Some life phases can also affect your bladder. For example, pregnancy and childbirth can change the tone of your vagina, your pelvic floor muscles, and the ligaments that support your bladder.

Nerve damage from diseases and trauma can also cause mixed signals between the brain and the bladder. Medications, alcohol, and caffeine can also affect signals to the brain and cause the bladder to overflow.

If you have OAB, you may feel the need to go to a bathroom — a lot. According to the National Association for Continence, a quarter of adult women experience urinary incontinence. This means that you involuntarily leak urine when you send the urge to go. Fortunately, there are steps you can take to manage OAB and lower your risk of accidents.

The first line of treatments for OAB are non-medical. This includes:

Kegel exercises: Also known as pelvic floor muscle exercises, kegels help you stop your bladder’s involuntary contractions. It may take six to eight weeks before you notice an effect.

Bladder retraining: This may help with gradually building up the amount of time you can wait to go to the bathroom when you need to urinate. It can also help lower your risk for incontinence.

Double voiding: Wait a few minutes after urinating and go again to make sure that your bladder is completely empty.

Absorbent pads: Wearing liners may help with incontinence so that you don’t have to interrupt activities.

Maintaining a healthy weight: Extra weight puts pressure on the bladder, so weight loss can help ease symptoms.


Your doctor can prescribe medications if kegels and bladder retraining doesn’t work. These medications help relax the bladder and improve symptoms of OAB.

Even though decreased estrogen levels affect your bladder and urethra, estrogen therapy may not be an effective treatment. According to the Mayo Clinic, there isn’t sufficient scientific evidence to support the use of estrogen creams or patches to treat OAB. Hormone therapy isn’t FDA approved for the treatment of OAB or incontinence, and is considered an “off-label use” for these conditions.

Still, some women say that topical estrogen treatments help control their urinary leaking and the urge to go. These treatments may improve the flow of blood and strengthen the tissue around your urethra. Talk to your doctor if you’re interested in hormone replacement therapy.

Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

Learn more: All about off-label prescription drug use »

Schedule an appointment with your doctor if you:

  • urinate more than eight times per day
  • regularly get up in the night to urinate
  • experience frequent leaking of urine
  • have changed your activities to accommodate symptoms of OAB or urinary incontinence

Don’t let OAB interfere with how you enjoy everyday activities. Treatments for OAB are effective and can help you to live a healthy, active life.

Keep reading: Natural treatments for OAB »