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Embracing Urinary Changes During (Peri)Menopause with Confidence

Menopause is a natural and empowering transition in a woman’s life, but it can bring about several changes, some of which feel unexpected. Perimenopause—the phase leading up to menopause— often sees women navigating new experiences like recurrent urinary tract infections (UTIs), incontinence, and overactive bladder. These changes can be opportunities to embrace knowledge, make informed choices, and maintain a high quality of life.

Understanding Urinary Changes

As women age, estrogen levels begin to decline. Many are unaware that estrogen has a major role in the urinary system. It helps maintain the strength of the urinary sphincter, keeps the urethral mucosa thick and maintains bladder compliance. This natural shift can affect the tissues of the urinary tract, making you susceptible to infection, incontinence and overall discomfort. 

Recurrent Urinary Tract Infections (UTIs)

Recurrent UTIs, defined as two or more infections in six months or three or more in twelve months, are a common issue during menopause. The thinning of vaginal and urethral tissues increases susceptibility to infection. Additionally, the loss of estrogen raises vaginal pH, creating an unfavourable environment for protective lactobacilli bacteria. As these beneficial bacteria diminish, the risk of infection rises. It is estimated that up to 20% of women over the age of 60 experience recurrent UTIs, highlighting the importance of proactive healthcare.

Urinary Incontinence

Urinary incontinence—the involuntary leakage of urine—can manifest in several forms. Stress incontinence occurs when physical movement or activity, such as coughing or sneezing, puts pressure on the bladder and causes leakage. Urge incontinence involves a sudden, intense urge to urinate, followed by involuntary urine leakage. These issues can stem from weakened pelvic floor muscles and changes in bladder function. The treatment for incontinence tends to focus on support of the pelvic floor with physical therapy, pessary devices or surgery. With estrogen receptors present in the pelvic floor it is hypothesized that estrogen plays a key role in pelvic floor connective tissue.

Overactive Bladder

Overactive bladder (OAB) is a condition characterized by a sudden, uncontrollable urge to urinate, often accompanied by increased frequency of urination and, in some cases, urinary incontinence. It is not a disease but rather a group of urinary symptoms.

While multiple factors can contribute to OAB, one of the most common is the loss of estrogen. The urethra and bladder both contain estrogen receptors which makes it subject to atrophy when there is estrogen loss.

Where to start with solutions:

  1. Lifestyle Modifications:

  • Healthy Diet: A balanced diet rich in fruits, vegetables and fibre can prevent constipation, which can exacerbate urinary issues. Limiting caffeine and alcohol, which can irritate the bladder, is also beneficial.

  • Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegels can improve bladder control and reduce incontinence. This is best done with the guidance of a pelvic floor physiotherapist.

  • Bladder Training: Gradually increasing the time between bathroom visits can help train the bladder to hold urine longer, reducing urgency and frequency.
  1. Supportive Products: External products applied to the vulva or vagina can alter pH levels or contain ingredients that increase the risk of infection. It’s crucial to use high-quality products, such as IRIS personal lubricant, which is pH-balanced, has the correct osmolarity, and is free from harmful ingredients.

  2. Topical Hormone Therapy: For some, applying a low-dose estrogen cream can help rejuvenate the tissues of the urinary tract, and improve many urinary symptoms as well as vaginal symptoms.

Menopause marks the beginning of a powerful transformation. With the right knowledge and support, you can navigate these changes with grace and confidence, maintaining a vibrant and fulfilling lifestyle. Let’s embrace this journey together, break the silence, and celebrate the strength that comes with change.

Empower Yourself and Others! Menopause is an opportunity for growth and empowerment. Spread the word by sharing this blog, and come meet us at the National Menopause Show on October 26th to connect, learn, and flourish together!

Written by: Dr. Dolores Fernandez, ND, MSCP from IRIS Inc.