Menopause and its Symptoms
Menopause is a term used to describe the stage in a woman’s life where the menstrual periods come to an end. You are said to have menopause if you do not have any periods for 12 straight months.(1,2,3) Once this happens, your menstrual cycles come to an end. The time period leading up to your final period is called perimenopause.
During perimenopause, the body undergoes many changes, especially in your hormone levels. These changes can sometimes begin even several years before your final period happens and may cause several other symptoms as well. After perimenopause, you reach menopause, the official end of your menstrual cycle or periods.(4, 5)
For most women, this phase of life happens by the time they reach their late forties or early fifties. The average age of menopause in the United States is estimated to be 51 years.(6) Some of the signs and symptoms you experience before and during menopause include:
- Hot flashes or having a sudden surge of heat, especially in the upper part of the body.
- Changes in your period that start to differ from your regular cycle.
- Having trouble sleeping.
- Changes with how you feel about sex.
- Changes in the vagina.
- Changes in bladder control.
In many cases, these changes in bladder control increase the risk of developing an overactive bladder (OAB). A 2015 survey carried out on 351 women in China found that 7.4 percent of them had an overactive bladder. The survey also found that women who experienced menopausal symptoms had a greater risk of developing an overactive bladder and also had the symptoms of overactive bladder.(7)
What is an Overactive Bladder and What are Its Symptoms?
An overactive bladder is a term used for a variety of symptoms that are related to the urinary system. The most common symptom of an overactive bladder has a frequent and urgent need to urinate that is not easy to control.(8,9) A person with an overactive bladder is prone to feel like they need to pass urine urgently and that too many times during the day and at night. They may also experience urine incontinence or an unintentional loss of urine. In fact, many people with this condition notice they have difficulty reaching the bathroom without leaking urine.
It is estimated that nearly 30 percent of men and 40% of women in the United States experience of overactive bladder.(13) Many people having this condition often avoid seeking treatment as they feel embarrassed. Many times, people are not aware of how to bring up such symptoms with their doctor, or they assume that there is no treatment for their symptoms. Many even consider these symptoms to be a normal part of getting older or caused by something they did.(14)
When you experience these symptoms at an older age, it increases your risk for falls because you often find yourself rushing to the bathroom. Old age is also linked with a higher risk of osteoporosis, so when you fall, it might often be more serious. Studies have found that older women with overactive bladder and urinary incontinence have a greater risk for poor self-assessment, disability, sleep quality, and well-being.(15)
This is why it is very important to seek an appointment with your doctor at the earliest if you notice a change in your bladder or urinary symptoms. It might be that your sudden urge to urinate is a symptom of an overactive bladder.
Why Does Menopause Increase the Risk of Overactive Bladder?
There are several reasons why menopause increases the risk of an overactive bladder in older women. One of the main reasons is the impact of changing levels of estrogen on the bladder and urethra. Estrogen is the major female sex hormone produced primarily by the ovaries. Estrogen is necessary for sexual and reproductive health. Estrogen also has a role to play in ensuring the health of other organs and tissues in the body, including the urinary tract and pelvic muscles.(16)
Before reaching menopause, the body receives a steady supply of estrogen to work towards preserving the flexibility and strength of the supporting bladder and pelvic tissues. However, during perimenopause and menopause, the estrogen levels in women fall drastically. This causes the tissues to weaken. At the same time, low levels of estrogen can also lead to a build-up of muscular pressure around the urethra.(17)
Such changes in hormonal levels also increases the risk of contracting urinary tract infections (UTIs) during menopause and perimenopause. Many urinary tract infections also often have similar symptoms like overactive bladder. If you notice any changes in your urinary patterns, you should consult a doctor at the earliest.(18)
In older women, another common risk factor that can be observed are pelvic floor disorders, such as urinary incontinence and overactive bladder. There are also certain life events that affect the bladder. For example, childbirth and pregnancy can have an effect on the pelvic floor muscles, tone of the vagina, and the supporting ligaments of the bladder.(19)
Nerve damage from certain diseases and trauma can also cause changes in the signaling that goes on between the brain and the bladder. Alcohol, caffeine, and some medications are also known to disrupt the signals to the brain, causing the bladder to overflow.(20)
Is It Possible To Manage Overactive Disorder in Menopausal Women?
It is common to feel the need to go to the bathroom if you have an overactive bladder. According to statistics released by the National Association for Continence, nearly a quarter of adult women are known to experience urinary incontinence.(21) Urinary incontinence means involuntary leakage of urine when you feel the urgent need to go. This is one of the main symptoms of an overactive bladder. There are several steps you can take to manage the symptoms of an overactive bladder and also reduce the risk of having any unwanted accidents.
Fortunately, the first line of treatments for managing an overactive bladder. This includes:
- Bladder Retraining: Retraining of the bladder helps build up the amount of time you can wait before having to go to the bathroom when you have to urinate. This helps reduce the risk of incontinence as well.(22)
- Kegel Exercises: Kegel exercises are very popular with women of all ages. Also known as pelvic floor exercises, Kegel exercises can help stop the involuntary contractions of the bladder. However, you need to keep practicing them dedicatedly for at least six to eight weeks before you begin to notice any positive change.(23)
- Watching Your Weight: Extra weight is known to exert extra pressure on the bladder. Maintaining a healthy weight can help relieve some of the symptoms of an overactive bladder.
- Wearing Absorbent Pads: Wearing panty liners that are absorbent can help you deal with incontinence, and you don’t have to immediately rush to the bathroom, interrupting whatever you are doing.
- Double Voiding: After urinating, wait for a few minutes and try to go again to ensure that the bladder is completely empty.
Conclusion: Can Estrogen Therapy Help?
Estrogen therapy is not going to be much of a help in dealing with an overactive bladder and its symptoms, even though the symptoms occur due to lower levels of estrogen that impact the urethra and bladder. There is a lack of scientific evidence to show that the use of estrogen patches or creams can help relieve the symptoms of overactive bladder. Hormonal therapy is also not approved by the US Food and Drug Administration (FDA) for the treatment of urinary incontinence or overactive bladder. They are typically considered to be an ‘off-label use’ for treating these conditions.
Nevertheless, many women say that they have benefitted from using optical estrogen treatments for controlling urinary leakage. Estrogen therapy may help boost the blood flow and strengthen the tissue around the urethra. If you are interested in hormone replacement therapy, you can ask your doctor for further guidance on the same and about whether or not it will benefit your symptoms.
- Greendale, G.A., Lee, N.P. and Arriola, E.R., 1999. The menopause. The Lancet, 353(9152), pp.571-580.
- McKinlay, S.M., Brambilla, D.J. and Posner, J.G., 1992. The normal menopause transition. Maturitas, 14(2), pp.103-115.
- Utian, W.H., 1999. The International Menopause menopause-related terminology definitions. Climacteric, 2(4), pp.284-286.
- Mckinlay, S.M., 1996. The normal menopause transition: an overview. Maturitas, 23(2), pp.137-145.
- Rogers, A.R., 1993. Why menopause?. Evolutionary Ecology, 7(4), pp.406-420.
- National Institute on Aging. 2021. What Is Menopause?. [online] Available at: <https://www.nia.nih.gov/health/what-menopause> [Accessed 18 October 2021].
- Chen, Y., Yu, W., Yang, Y., Duan, J., Xiao, Y., Zhang, X., Wu, S. and Bai, W., 2015. Association between overactive bladder and peri-menopause syndrome: a cross-sectional study of female physicians in China. International urology and nephrology, 47(5), pp.743-749.
- Ouslander, J.G., 2004. Management of overactive bladder. New England Journal of Medicine, 350(8), pp.786-799.
- Stewart, W., Van Rooyen, J., Cundiff, G., Abrams, P., Herzog, A., Corey, R., Hunt, T. and Wein, A., 2003. Prevalence and burden of overactive bladder in the United States. World journal of urology, 20(6), pp.327-336.
- Wein, A.J. and Rovner, E.S., 2002. Definition and epidemiology of overactive bladder. Urology, 60(5), pp.7-12.
- Milsom, I., Stewart, W. and Thuroff, J., 2000. The prevalence of overactive bladder. Am J Manag Care, 6(11 Suppl), pp.S565-73.
- Wein, A.J. and Rackley, R.R., 2006. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. The Journal of urology, 175(3S), pp.S5-S10.
- Urologyhealth.org. 2021. Overactive Bladder (OAB): Symptoms, Diagnosis & Treatment – Urology Care Foundation. [online] Available at: <https://www.urologyhealth.org/urology-a-z/o/overactive-bladder-(oab)> [Accessed 16 October 2021].
- Steers, W.D., 2002. Pathophysiology of overactive bladder and urge urinary incontinence. Reviews in urology, 4(Suppl 4), p.S7.
- Tomaszewski, J., 2014. Postmenopausal overactive bladder. Przeglad menopauzalny= Menopause review, 13(6), p.313.
- Collins, A. and Landgren, B.M., 1994. Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: a population-based study. Maturitas, 20(2-3), pp.101-111.
- Wend, K., Wend, P. and Krum, S.A., 2012. Tissue-specific effects of loss of estrogen during menopause and aging. Frontiers in endocrinology, 3, p.19.
- Caretto, M., Giannini, A., Russo, E. and Simoncini, T., 2017. Preventing urinary tract infections after menopause without antibiotics. Maturitas, 99, pp.43-46.
- Luber, K.M., Boero, S. and Choe, J.Y., 2001. The demographics of pelvic floor disorders: current observations and future projections. American journal of obstetrics and gynecology, 184(7), pp.1496-1503.
- Hallock, J.L. and Handa, V.L., 2016. The epidemiology of pelvic floor disorders and childbirth: an update. Obstetrics and Gynecology Clinics, 43(1), pp.1-13.
- NAFC. 2021. Women’s Bladder Health Conditions – NAFC. [online] Available at: <http://www.nafc.org/womens-conditions/> [Accessed 18 October 2021].
- Aslan, E., Komurcu, N., Beji, N.K. and Yalcin, O., 2008. Bladder training and Kegel exercises for women with urinary complaints living in a rest home. Gerontology, 54(4), pp.224-231.
- Cavkaytar, S., Kokanali, M.K., Topcu, H.O., Aksakal, O.S. and Doğanay, M., 2015. Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. Journal of Obstetrics and Gynaecology, 35(4), pp.407-410.
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