Aging is a part of life, and while it's inevitable, you don't need to suffer through the urology-related symptoms that many people view as normal. Urinary symptoms are related to several factors, from age to lifestyle, underlying conditions, and more. But did you know that menopause also plays a role in several urological conditions? Here, we'll go over everything you need to know regarding urinary symptoms in women after menopause.
What Happens During Menopause?
When a woman goes through menopause, estrogen production drops significantly. This occurs naturally once the ovaries have released all their functioning eggs and stop making estrogen. Although estrogen is still made by fat cells, the drastic change in hormone levels can result in several different side urological effects and urinary problems in postmenopausal women.
The decline in estrogen is often associated with urogenital atrophy in women. This essentially means that the muscle necessary for a healthy urinary tract and vagina starts to decline gradually. For example, the bladder lining begins to deteriorate, which can contribute to an increased risk of urinary incontinence. Vaginal atrophy can also occur, and pelvic floor muscles may weaken with age. These two factors can increase the risk of pelvic organ prolapse, which further contributes to bladder control issues like stress incontinence or urge incontinence.
It should be noted that although there is a higher rate of urinary problems in aging women, it's unknown whether it's due to changes in levels of the female hormone estrogen, aging, or a combination of the two. If you experience symptoms of vaginal atrophy or urinary problems, book an appointment with your doctor to discuss treatment options.
What is Genitourinary Syndrome of Menopause?
Genitourinary syndrome of menopause (GSM) is a condition that encompasses a range of symptoms affecting the genital and urinary systems of women during and after menopause. It doesn't occur to every woman going through menopause, but it seems to affect about 50%.
As estrogen levels decline during menopause, the tissues of the vagina, vulva, and lower urinary tract become thinner, drier, and less elastic, leading to discomfort and various symptoms. Common symptoms of GSM include vaginal dryness, itching, burning, and painful intercourse (dyspareunia). Additionally, women may experience urinary symptoms such as increased frequency, urgency, and a higher risk of urinary tract infections.
The condition was previously referred to as "vulvovaginal atrophy," but the term GSM is now preferred as it better captures the broader impact on both the genitals and urinary system. GSM can significantly affect a woman's quality of life, particularly with sexual health and comfort.
Menopause Symptoms
Many women start going through menopause between 45 and 55 years. At this time, menopause manifests with an array of symptoms. Some of the most common symptoms of menopause include:
- Hot flashes
- Changes in mood
- Changes in skin conditions
- Difficulty sleeping
- Hair loss or thinning
- Headaches or migraines
- Joint stiffness
- Brain fog
- Vaginal dryness
- Vaginal burning
- Vaginal itching
- Urinary incontinence
- Frequent urination
- Recurrent urinary tract infections
- Nocturia
- Painful intercourse
- Bleeding after intercourse
- Less natural lubrication
- Changes to the vaginal acidity
- Reduced libido
Urological Concerns After Menopause
Recent research has shown that, in addition to menopausal vaginal atrophy, estrogen also plays a role in a healthy urinary tract. The drop in estrogen can create more sensitivity in the bladder lining, making it more difficult to control your need to urinate. A decline in estrogen also leads to higher rates of inflammation and irritation in the urethra due to the increased sensitivity from atrophy. The most prevalent urological changes that occur in women after menopause include the following:
Urinary Incontinence
Urinary incontinence (UI) during menopause is one of the most common symptoms that women with GSM notice. The most prevalent symptom is the involuntary leakage of urine or the loss of bladder control. Two primary types of UI that are associated with postmenopausal changes are stress and urge incontinence.
Stress incontinence is a type of urinary incontinence that occurs when physical activities like coughing, sneezing, laughing, or exercising put pressure on the bladder, leading to unintentional urine leakage. It often results from weakened pelvic floor muscles, which can be caused by factors such as childbirth, aging, surgery, and a decline or lack of estrogen.
Urge incontinence, on the other hand, is characterized by a sudden, intense urge to urinate, followed by an involuntary loss of urine. This occurs because the bladder muscles contract uncontrollably, even when the bladder isn't full. Overactive bladder is also a menopausal urinary condition that may occur.
Urinary Frequency
Women who are experiencing genitourinary syndrome of menopause also tend to notice a greater urge to urinate throughout the day and at night (nocturia). As estrogen levels decline, the tissues in the bladder and urethra can become thinner, less elastic, and more prone to irritation. This hormonal change can lead to a decrease in bladder capacity and a heightened sensitivity, causing women to feel the urge to urinate more frequently, even when the bladder isn't full. Additionally, the weakening of pelvic floor muscles during menopause can further contribute to urinary frequency by reducing bladder control.
Urinary Tract Infections (UTI)
Urinary tract infections also become more common for women during and after menopause. When estrogen levels drop during menopause, the tissues in these areas can become thinner, drier, and less resilient, making them more susceptible to recurrent bacterial infections like UTIs.
Additionally, the natural balance of vaginal flora can be disrupted, reducing the presence of beneficial bacteria that typically protect against harmful pathogens. This increased vulnerability, combined with a weakened immune response often accompanying aging, can lead to a higher incidence of UTIs.
Treatment Options for Vaginal and Urinary Postmenopausal Challenges
Luckily, there are several things that you can do to help prevent serious discomfort and alleviate symptoms of declining urinary functions. In addition to making healthy lifestyle changes that support your urologic health, the following treatments can be explored.
Lifestyle Modifications for Bladder Control
Lifestyle modifications can play a significant role in managing menopausal urological symptoms. Dietary changes, such as reducing caffeine and alcohol intake, can help decrease bladder irritation and urinary frequency. Regular pelvic floor exercises (Kegels) are crucial for strengthening the muscles that support the bladder and urethra, which can reduce stress incontinence and improve overall bladder control.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) is one of the most effective treatments for alleviating menopausal symptoms, including those affecting the urinary and genital systems. By restoring estrogen levels, HRT can help to rejuvenate the thinning tissues of the vagina and urethra, reduce urinary frequency, and improve bladder control.
However, some women are not eligible to receive hormone therapy. Women who have had breast cancer in the past are advised against taking HRT, along with individuals who have recently had liver disease, a cardiovascular event, stroke, or angina. Talk to your doctor to learn whether you're a good candidate for HRT.
Topical Vaginal Estrogen
For women who cannot take systemic hormones, topical vaginal estrogen provides a localized option that directly targets the affected areas. This aims to provide the same outcomes as HRT but requires daily application.
When applied regularly, topical estrogen can help alleviate vaginal symptoms like dryness, irritation, and discomfort without significantly affecting overall hormone levels. Topical estrogen may also help improve urinary health as the structures regain muscle from a localized application.
Vaginal Laser Therapy
For those seeking non-hormonal treatments, vaginal laser therapy has emerged as an innovative option. This minimally invasive procedure stimulates collagen production in the vaginal tissues, improving elasticity and moisture and reducing symptoms of GSM, including urinary issues. However, this is technically not an FDA-approved treatment, so always talk to your OB/GYN regarding your options before scheduling this treatment. A lack of FDA approval could indicate negative side effects and usually means your insurance won't cover it.
Vaginal Moisturizers and Lubricants
Finally, using vaginal lubricants and moisturizers can provide you with immediate relief from vaginal dryness and discomfort. While this won't do anything to help with the urinary symptoms associated with menopause, it can improve your overall comfort during daily activities and intimate moments.
It's also important to see your urologist to understand the emergence of any underlying conditions better. Although a gynecologist can help with vaginal atrophy, a urologist is still recommended. If you're experiencing a urologic condition, regardless of age, Byram Healthcare carries a wide selection of high-quality urologic supplies to help you manage symptoms. Contact us today to learn more or speak with a professional regarding questions or ongoing management.
