Perimenopause is the transitional period before menopause. On average, it can take 4-7 years to reach menopause, although how long it takes can be quite variable for each person. Menopause is considered complete once there has been no period for 12 months. During perimenopause, significant hormonal changes can occur; it impacts each person differently but can cause unwanted symptoms, including changes in bladder control.
As a nurse, I see many women suffer through this transitional phase in life, as it can be difficult to know and understand what is happening to your body. Symptoms such as incontinence can be embarrassing and difficult to discuss with others.
Gaining a clear understanding of adult bladder control and how perimenopause affects your body can help you manage any symptoms that arise.
What Happens to Hormones During Perimenopause?
During perimenopause, the ovaries start to shut down, producing fewer hormones, most notably estrogen. As estrogen levels decline, it can affect the regularity of your period, causing it to come at different intervals, be longer or shorter, and even change the amount of flow. The changing hormone levels also directly contribute to perimenopause symptoms including:
- Irregular or missed periods
- Mood changes
- Hot flashes
- Sweating at night
- Vaginal dryness
- Urinary urgency and incontinence
- Difficulty sleeping
How Estrogen Changes Can Affect the Urinary System
While other hormones, such as progesterone, are also impacted during perimenopause, estrogen causes changes associated with the bladder and pelvic floor. Ovaries are the major producers of estrogen in the female body before menopause. The ovaries begin to shut down as menopause approaches, which signifies the end of a woman’s reproductive years. As the ovaries shut down, they produce less estrogen.
When estrogen declines, it causes the muscles and tissues in the urinary system and pelvic floor to atrophy (shrink), thin, and have less elasticity. These changes within the bladder cause urinary function to become less predictable, as the bladder can become irritated more easily and overall weaker. These changes can cause symptoms such as leaking, the sudden urge to urinate, needing overnight leak protection for frequent nighttime trips, and even recurring urinary tract infections.
Bladder control changes from perimenopause can cause any of these issues
Stress Incontinence: Leaking urine when coughing, sneezing, or exercising.
Urge Incontinence: The sudden urge to urinate that comes with little to no warning.
Mixed Incontinence: A combination of both stress and urge incontinence.
Urinary Tract Infections: Urinary tract infections (UTIs) can become more common during perimenopause and after menopause due to changes in the tissue in the vagina and urethra. The tissue thins and becomes less elastic due to declining estrogen, which makes it easier for bacteria to travel up the urethra and cause bladder infections.
The Pelvic Floor Connection
The pelvic floor muscles are also impacted by estrogen during perimenopause and can become dysfunctional and weaker. They provide less support to the bladder and urethra and can also contribute to bladder control symptoms. The muscles of the pelvic floor help to support the bladder and bowels, so declining estrogen impacts these muscles the same way it impacts the bladder.
Other Factors That Can Contribute to Bladder Changes
While perimenopause and its hormonal changes cannot be avoided, it is also important to note that other factors can contribute to changes in your bladder at the same time. Identifying and addressing the cause of bladder control issues is important to successful treatment and management.
These are some other factors that can affect bladder control:
- Pregnancy and childbirth
- Changes in weight
- Chronic constipation
- Medications
- Diabetes
- Cardiovascular Disease
- Urinary tract infections
- Pelvic surgeries or traumas
- Certain physical activities or changes in activity level
The Role of Hormone Replacement Therapy
Hormone replacement therapy (also called HRT) is commonly used to treat and manage symptoms associated with perimenopause. HRT can help balance out estrogen and progesterone levels within the body, therefore reducing or eliminating symptoms related to fluctuating and declining hormone levels.
The use of HRT has been controversial at times due to conflicting studies and limited data. Currently, the use of HRT is recommended for women with perimenopausal and menopausal symptoms. The use of HRT can have higher risks for some women than others, and each woman needs to discuss the risks and benefits with their health care provider.
HRT comes in different forms such as pills, creams, and topical patches. Depending on the symptoms being targeted, your medical provider can prescribe appropriate treatment.
Managing Bladder Control During and After Perimenopause
Managing bladder control often requires implementing multiple different strategies. These can include lifestyle changes, medications, and other medical interventions. Lifestyle changes are things you can start today that can help stabilize hormones. These are the most commonly recommended interventions:
Lifestyle Changes
- Eat a well-balanced diet, limiting or avoiding overly processed foods
- Take Calcium and Vitamin D if recommended by your healthcare provider
- Reduce caffeine and alcohol intake
- Maintain a regular sleep schedule
- Exercise routinely
- Avoid smoking
- Reduce stress when possible
Clinical Interventions
- Pelvic Floor Therapy: Pelvic floor therapy is completed with a specialized therapist who can help determine your individual pelvic floor concerns and create a program to help correct the issues. Pelvic floor therapy can help with pelvic pain, discomfort, incontinence, prolapse, and other associated conditions.
- Medications: As discussed above, HRT is a common medication treatment for perimenopause symptoms. Some other medications used to help manage bladder control are Oxybutinin (used to help with overactive bladder) and vaginal estrogen (a non-systemic hormonal option).
- Pessaries: A small device placed into the vagina that supports the bladder internally. Pessaries are often effective for people experiencing stress incontinence or who have organ prolapse.
- Incontinence products: Disposable products designed to manage incontinence, ranging from small leaks to full bladder loss. Incontinence products are a discreet way to manage urinary incontinence while still being able to leave the house and continue activities. Incontinence products come in numerous sizes and styles to fit your specific needs, including specialized protective underwear for women. Browsing an online product catalog or using an incontinence product guide allows you to get an idea of the different offerings, such as liners, pads, pull-ups, and more heavy-duty products for overnight.
Know The Changes, Know Your Options
Experiencing bladder changes during perimenopause can be unsettling, but they do not have to be the new normal. There are many strategies to treat and manage incontinence. Taking a proactive approach and making positive lifestyle changes can help reduce the chance of experiencing bladder control issues. If you begin to notice changes in bladder control, it is always important to discuss them with a healthcare provider to create a targeted plan.
