How Menopause Affects a Woman's Urinary Tract

As you age, you may notice some changes to your bladder and vagina that may affect your intimate life. What might you expect as you approach menopause? How does the change in hormones at menopause affect your vagina, urinary tract, and sexual health, and what can you do to manage these unpleasant side effects?

The changes in your urinary tract and vagina are not always a welcome introduction to menopause. Thankfully, there are often several solutions for each of these symptoms that can reduce the impact they have on your quality of life.

Menopause and Your Urinary Tract

It has been debated whether the changes in a woman's urinary tract with age are due to menopause and the lack of estrogen or are related to the aging process alone. However, it is known that the bladder is loaded with estrogen receptors, so the reduction of estrogen that happens in menopause probably doesn't help.

With age, the bladder begins to lose both its volume and its elasticity, and it's normal to have to go to the bathroom more frequently. As the bacteria concentration in your genital region increases (often due to weakening of the vaginal walls,) your urethra may thin, allowing bacteria easier access to your bladder. For these reasons, urinary tract infections (bladder infections and/or kidney infections) are more common as women age. This risk begins to increase within four or five years of your final menstrual period.

The bladder also begins to thin, leaving women more susceptible to incontinence, particularly if certain chronic illnesses (such as diabetes) or recurrent urinary tract infections are also present.

The pelvic muscles weaken as you age. You may find that exercise, coughing, laughing, lifting heavy objects, or performing any other movement that puts pressure on the bladder can cause small amounts of urine to leak. Lack of regular physical exercise may also contribute to this condition.

It's important to know that incontinence is usually a treatable condition that warrants medical evaluation. Recent research has shown that bladder training is a simple and effective treatment for many cases of incontinence and is less expensive and safer than medication or surgery.

Managing Bladder Leaks

It's important to determine what type of incontinence you may be experiencing. Types may include:

• Stress incontinence: If you find yourself leaking urine when you laugh, cough, or sneeze, you may be experiencing stress incontinence. This type of incontinence is more common after menopause and childbirth and is related to the weakening of your pelvic floor muscles. Options for treatment may include pelvic floor muscle exercises (the classic Kegel exercises,) medication, the use of a medical device, or surgery.
• Overactive bladder: If you find yourself urinating often, you may be living with an overactive bladder. Make an appointment with your doctor if you are urinating more than six to eight times a day. They may recommend medications like Myrbetriq (mirabegron) or Gemtesa (vibegron), both approved to treat this disorder.
• Urge incontinence: Urge incontinence or a "spastic bladder" is related to involuntary bladder muscle contractions. It is most often caused by problems in the peripheral or central nervous system which result in nerve damage. If you notice that you have to urinate quickly when you hear water running, you may be experiencing this type of incontinence. Treatment may include addressing the cause (whether a spinal cord injury, a stroke or other neurological condition) and medications designed to reduce involuntary contractions in your bladder.
• Transient incontinence: An example of transient incontinence in women after menopause is that associated with a urinary tract infection.
• Overflow incontinence: Much more common in men, overflow incontinence is usually continuous dribbling related to obstruction in the urethra.

Specific treatment for the incontinence you are experiencing will depend on a careful evaluation by your healthcare professional. Pelvic floor muscle exercises can be helpful for stress incontinence, and many gynecologists recommend beginning these exercises before you have a problem.

Managing Urinary Tract Infections

If symptoms such as painful or overly frequent urination occur, as in the case of a urinary tract infection, consult your healthcare provider. Infections are easily treated with antibiotics but often tend to recur. To help prevent these infections, urinate before and after intercourse, make sure your bladder is not full for long periods, drink plenty of fluids, and keep your genital area clean. Douching is not considered to be effective in preventing infection. A vaccine is being developed, which may help prevent recurrent bladder infections.

Some women who experience recurrent urinary tract infections associated with menopause may require low-dose antibiotics. A 2016 study also found that a supplement of hyaluronic acid, chondroitin sulfate, curcumin, and quercetin was effective in reducing the frequency of urinary tract infections in postmenopausal women, especially when combined with topical vaginal estrogen therapy.

Menopause and Your Vagina and Sexual Health

As you approach menopause, you'll notice a few shifts in your body. The walls of your vagina will become thinner, less elastic, and more vulnerable to infection. Dryness usually increases as well. These changes alone can make sexual intercourse uncomfortable or painful.

Managing Vaginal Dryness

Vaginal dryness is a symptom of menopause that can damage your quality of life and affect your sexual relationship, but it is one that most women do not report to their healthcare providers. That's unfortunate, as there are many ways in which this can be managed.

Personal lubricants are often a first step, and water-soluble lubricants are typically recommended as they are less likely to increase your risk of infection. In general, products such as petroleum jelly should be avoided as many women are allergic to these products.

Some women may benefit from hormone replacement therapy, though concerns about the increased risk of breast cancer with some preparations have reduced use in recent years. Ask your doctor about the benefits and risks of using hormone therapy after menopause.

Other options include topical hormones (estrogen or testosterone) or vaginal laser and radiofrequency treatments, such as FemiLift, FormaV, or MonaLisa Touch.

Finally, staying well hydrated by drinking plenty of water and fluids not only reduces vaginal dryness but is helpful in many other ways as you age.

Reframing Your Physical Symptoms

Even with the possible solutions mentioned above, the changes in your reproductive and urinary organs at menopause can be frustrating. Sometimes, rather than a physical solution to these challenges, a shift in mindset might be the answer. If a person cannot change a situation in their life, sometimes they can change their emotional response to the situation. This is where reframing can help.

Cognitive reframing is a tool in which a situation does not change, but your reaction to the situation or your perspective on the situation does change. With menopausal symptoms, this may include looking not at the negatives of your situation, but the positives instead. Rather than focusing on your vaginal dryness and how it affects your sex life, perhaps focus on how you are free to have sex whenever you wish without the thought of birth control. If the cost of vaginal lubricants disturbs you, consider how much money you are saving on pads and tampons. There is also a freedom that comes with no longer needing to make sure you have these menstrual products on hand.

Reframing is not always easy to do, and sometimes you may need to "fake it until you make it." Remember there are silver linings in nearly any situation.

Trying to create a sense of gratitude can also be helpful. Many people have found that keeping a gratitude journal is a good way to shift their frame of mind from the negative to the positive. Try to think of three positives in your life every day.

A Word From Verywell

The reduction in estrogen at menopause, combined with normal aging, may result in symptoms of vaginal dryness, incontinence, and urinary tract infections. The good news is there are several ways to reduce these symptoms, which is why it's important to talk to your healthcare provider about your symptoms. If menopause or age are causing you discomfort, make an appointment with a healthcare professional to see what options are available.