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Menopause and Urinary Health

Article Content
Dr. Michael Green
Medically Reviewed byDr. Michael GreenMD, OB/GYN Chief Medical OfficerRead Bio
Written ByNancy BelcherPhD

With age, the hormones estrogen, progesterone, and testosterone decrease, and these hormone fluctuations are to blame for the various symptoms women experience throughout the menopause transition. Some symptoms are more well-known, like hot flashes, brain fog, and vaginal dryness, but many women don’t realize that decreased hormones actually affect urinary health too.

Reduced levels of estrogen can cause a thinning of the lining of the urethra. Additionally, the surrounding pelvic muscles may weaken with aging – a process known as pelvic relaxation. As a result of the decreased hormones and the weakening muscles, women are at increased risk for urinary incontinence (the involuntary leakage of urine) at this stage. The main risk factors for developing incontinence are vaginal childbirth and increased age. Although women can experience both urinary incontinence (UI) and urinary tract infections (UTIs) throughout their lives, women in the menopause transition tend to experience UTIs and UI with more frequency.

Urinary Incontinence

This symptom may be a familiar experience… peeing a little when you cough, sneeze, exercise, or laugh. This can be partially due to weakened muscles from aging and pregnancy, but decreasing hormones is another one of the causes of urinary incontinence. Hormones work to keep your bladder and urethra healthy, so lower levels of estrogen and testosterone that come with menopause can cause pelvic floor muscles to weaken. As these hormone levels continue to drop steadily, low estrogen bladder symptoms can worsen. This too contributes to the weakening of the pelvic floor muscles and the lining of the bladder and urethra.

The bladder sits above the pelvic bones, and it’s supported by what is called the pelvic floor. This refers to a sling of tendons and muscles that support your internal organs, running between the pubic bone in the front and the tailbone at the back.

The pelvic floor muscles support the uterus, bladder, and colon. The bladder relaxes and fills with urine throughout the day, and if it’s working properly, the small sphincter that opens and closes to release urine will keep the bladder closed, until you can use the bathroom. During pregnancy, and then with menopause, the pelvic floor muscles can be weaker and less capable of holding urine, meaning the sphincter can open unexpectedly.

Incontinence from pregnancy usually abates once the baby is born, but menopause incontinence tends to worsen with time if not treated. Most of the time leakage is only a few drops of urine, but it can become a full loss of control.

Types of incontinence:

  • Stress Incontinence: loss of urine due to physical pressure on the bladder. The most common symptoms are leakage of urine with coughing, laughing, sneezing, or lifting objects. Stress incontinence is common during perimenopause.

  • Urgency Incontinence: loss of urine due to an urgent need to urinate (aka “overactive bladder”), which is caused by overly active or irritated bladder muscles. The most common symptom is the frequent and sudden urge to urinate, with occasional leaks. The effect of menopause on the bladder can cause this type of incontinence. 

  • Transient Incontinence: temporary loss of urine due to medication or UTIs.

Sex and Incontinence

Sex is an area where urinary incontinence can be particularly problematic. Approximately 25% of women with incontinence experience urinary leakage during intercourse; in reality, this number is likely much higher, since few women may want to discuss this symptom. This occurrence can be embarrassing, and it can lead to women avoiding sex or worrying so much about leakage that they can’t relax and enjoy sex. Urinating right before intercourse can be helpful to avoid this situation.

Other Factors Beyond Menopause

Menopause is not the only consideration, when looking for a cause of urinary incontinence. The following factors can play a role in your risk of UI:

  1. Drinking alcohol and carbonated or caffeinated drinks, like coffee or tea fills your bladder quickly and may make you feel like you need to use the bathroom more often.

  2. Drinking in the evenings can necessitate frequent trips to the bathroom and leaking throughout the night.

  3. Not eating enough fiber can lead to constipation, which adds stress to the pelvic floor.

  4. Extra weight, especially around the abdomen, increases pressure over the bladder.

  5. Infections in the urinary tract can cause UI, but after treatment, this should improve.

  6. Taking certain medications like steroids and diuretics can result in UI.

  7. Nerve damage can interfere with the signals between the bladder and brain, creating a situation where you leak because you don’t feel any urge to urinate.

Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are another potential symptom caused by decreasing hormones during the menopause transition. Some menopausal women have occasional UTIs, but others experience chronic UTIs that occur month after month and interfere with quality of life and sexual enjoyment.

A UTI can occur in any part of the urinary system, including the bladder, kidneys, ureters (tubes between kidneys and bladder), and urethra (the tube through which urine exits your bladder and leaves your body). As estrogen production in particular decreases in menopausal women, UTIs can occur more frequently. With less estrogen in your body, bacterial levels can change, making it easier for infection to occur. Additionally, vaginal tissue thins with age and decreasing estrogen, which makes it more prone to infection.

Tips for Preventing UTIs

  1. Drink plenty of water - up to eight glasses per day.

  2. Urinate before and after having sex.

  3. Wipe from front to back, after urination.

  4. Empty your bladder fully each time you urinate.

  5. Wear cotton fabrics and loose-fitting clothes, when possible.

  6. Change your underwear every day.

Solutions for Chronic UTIs

Antibiotics will clear UTIs, but it’s not safe to take antibiotics long-term or frequently, so it’s optimal to avoid getting UTIs in the first place. There are a few things you can do to reduce the incidence of menopause-related UTIs and postmenopausal UTIs:

  1. Lifestyle changes: Drinking plenty of water helps flush some harmful bacteria out of the urinary tract. Going to the bathroom whenever you have the urge, and allowing your bladder to empty as fully as possible, can also remove bacteria from your urinary tract. In addition, some women find that drinking cranberry juice or taking daily cranberry supplements helps ward off UTIs.

  2. Vaginal estrogen cream can restore hormone levels in your vagina. This helps prevent UTIs, because vaginal estrogen supports the good bacteria that help keep infection-causing bacteria in check. Vaginal estrogen is available as a twice-weekly cream.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”


Of the many symptoms that can manifest during the menopause transition, urinary symptoms may not be as widely recognized, but they can have far-reaching implications. However, you don’t have to endure menopause-related urinary incontinence and UTIs. Hormone Replacement Therapy (HRT) is an option for supplementing the hormones your body is producing less of to help tone your pelvic muscles and improve the lining of the urethra, as well as ward off infection-causing bacteria. Kegel exercises are also a helpful practice for training and strengthening the pelvic floor muscles.

At Winona, we understand how hard it can be to cope with menopause-related symptoms. That’s why we offer a full range of symptom treatment options on our online platform, available 24/7, with licensed physicians who can prescribe medications tailored to your unique needs. 

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