How Menopause Affects a Woman's Urinary Tract

What Will Happen To Your Bladder and Vagina During Menopause?

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What are some common urinary tract and vaginal changes after menopause and what can you do to manage them?. John Slater/DigitalVision/Getty Images

As you grow older, you may notice some changes to your nether regions that adversely 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?

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 instead related to the aging process alone.

We do know, however, that the bladder is loaded with estrogen receptors, so menopause probably doesn't help.

With age, the bladder begins to lose both its volume and its elasticity, and its 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. With weakening of the pelvic muscles with age, exercise, coughing, laughing, lifting heavy objects, or performing any other movement that puts pressure on the bladder may cause small amounts of urine to leak.

Lack of regular physical exercise may also contribute to this condition.

It's important to know, however, that incontinence is not really a normal part of aging, to be masked by using adult diapers. Rather, it is usually a treatable condition that warrants medical evaluation. In fact, 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.

How Will Menopause Affect 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. 

What Can I Do To Manage the Less Pleasant Aspects of Menopause?

The changes in our urinary tract and vagina, not to speak of generalized changes such as hot flashes, are not always a welcome introduction to the late summer and autumn of your life. Yet, for each of these symptoms there are often several possible solutions which can reduce the impact they have.

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 physicians. 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 has reduce use in recent years. Learn about some of the benefits and risks of using hormone therapy after menopause.

Other options include topical hormones (estrogen or testosterone.)

Finally, staying well hydrated not only reduces vaginal dryness, but is helpful in a number of other ways as you age.

Managing Bladder Leaks

Before addressing urinary incontinence in women, it's important to determine exactly what type of incontinence you are 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 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. It's "normal" to urinate six to eight times daily, and if you are urinating more frequently, make an appointment to see your doctor. The medication Myrbetriq (mirabegron) was approved in 2012 for treatment of 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 a continuous dribbling related to obstruction in the urethra.

The specific treatment for incontinence will depend on a careful evaluation and management of the particular type of incontinence you are experiencing. Pelvic floor muscle exercises can be very helpful for the common 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 doctor. Infections are easily treated with antibiotics, but often tend to recur. To help prevent these infections, urinate before and after intercourse, be sure your bladder is not full for long periods, drink plenty of fluids, and keep your genital area clean. Douching is not thought to be effective in preventing infection. Currently, a vaccine is being developed which may help prevent recurrent bladder infections.

For some women with recurrent urinary tract infections associated with menopause, low-dose antibiotics may be needed. 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 post-menopausal women, especially when combined with topical vaginal estrogen therapy.

Reframing Your Physical Symptoms at Menopause

Even with the possible solutions mentioned above, the changes in your reproductive and urinary organs at menopause can be irritating. Sometimes, rather than a physical solution to these challenges, a psychological "fix" might be the answer. When we can't change a situation in life, sometimes we can still change our emotional response to the situation. This is where reframing can be helpful.

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 change, but the positives instead. Instead of focusing on your vaginal dryness and how it affects sex, 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, think of 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 products on hand.

Reframing is not always easy to do, and sometimes you may need to "fake it until you make it." Yet, there are often a number of hidden 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 each and every day.

Bottom Line on Vaginal and Urinary Tract Changes With Menopause

The reduction in estrogen at menopause, combined with normal aging, may result in annoying symptoms of vaginal dryness, incontinence, and urinary tract infections. That said, there are a number of ways to reduce these symptoms and it's important to talk to your doctor. Menopause, in many ways, can be freeing, as you no longer need to cope with periods, and children are often becoming independent. Too many women simply "tolerate" these symptoms and never bring them up during appointments. If menopause or age may be causing you discomfort, make an appointment today to see what options are available.

Sources:

Cunningham, F. Gary., and John Whitridge Williams. Williams Obstetrics. New York: McGraw-Hill Education Medical, 2014. Print.

Karcher, C., and N. Sadick. Vaginal Rejuvenation Using Energy-Based Devices. International Journal of Women’s Dermatology. 2016. 2(3):85-88.

Kim, H., Kang, S., Chung, Y., Kim, J., and M. Kim. The Recent Review of the Genitourinary Syndrome of Menopause. Journal of Menopausal Medicine. 21(2):65-71.

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