Perimenopause and overactive bladder: Link and treatment (2022)

Perimenopause is the medical term for the transitional period before a person experiences menopause. Many symptoms are associated with perimenopause, including an overactive bladder (OAB). There are a number of other causes of OAB and a variety of treatment and management options.

The National Institute of Aging states that a person has experienced menopause when they have not had a period for 12 months. Perimenopause is the time leading up to that point and usually lasts around 7—14 years.

OAB is the term for a group of symptoms related to control of the bladder. People with OAB often experience a sudden urge to urinate.

This article will look at the link between perimenopause and OAB. It will also discuss symptoms and when to contact a doctor.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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OAB is the name for a group of symptoms connected to a person’s bladder control. OAB is also known as urgency incontinence.

Symptoms may include:

  • a strong and sudden urge to urinate immediately
  • being unable to hold urine long enough to get to a toilet
  • needing to urinate overnight
  • urinating more than eight times in 24 hours

A person may also feel that they might leak urine if they do not go to the bathroom immediately, even though it might not happen.

During perimenopause, a person’s hormone levels begin to change. Before this, high levels of the hormone estrogen help keep the muscles around the bladder and pelvic organs strong. After menopause, the ovaries make very low levels of estrogen, and this dramatic drop can weaken the bladder and the urethra.

According to the North American Menopause Society, low estrogen levels can cause the urethral and vaginal tissues to thin, and pelvic floor muscles can relax as a side effect of aging. This can lead to a person experiencing OAB and urinary incontinence.

Hormone changes can also lead to urinary tract infections (UTIs), which can cause similar symptoms to OAB. People should always consult a healthcare professional when they experience any new urinary symptoms.

Perimenopause is not the only cause of OAB. Many things can cause a person to experience OAB and other forms of urinary incontinence, including:

  • Childbirth: People may experience trauma during childbirth, which can cause bladder symptoms such as OAB or urinary incontinence.
  • Pregnancy: When a person is pregnant, their body goes through a number of physical changes. When the baby pushes down on the bladder, urethra, and pelvic floor muscles, it can lead to urinary urgency.
  • Medications: Certain medications can have the side effect of an overactive bladder. People should speak to a healthcare professional about the side effects of any medications they take.
  • Alcohol and caffeine: Both are diuretics, which encourage the body to make more urine. This can cause a person to need to urinate more frequently.
  • Nerve damage: If a person has nerve damage, it can interfere with the signals from the bladder to the brain, causing a person to experience bladder issues.
  • Constipation: If an individual experiences chronic constipation, it can apply pressure to the bladder and cause the need to urinate.
  • UTIs: UTIs can also cause a person to develop OAB. Irritation to the bladder can cause it to need to empty more frequently.

According to the Office on Women’s Health (OWH), multiple treatments are available for OAB, such as:

  • Prescription medications: Doctors may suggest one of several prescription medications to treat OAB. Certain medications, such as antimuscarinics or beta-3 agonists, can help to relax the bladder muscles. This can prevent the persistent urge to urinate.
  • Botox injections: Botox helps relax the muscles in the bladder and increase the volume of urine it can hold. A person may need injections approximately every 3 months.
  • Nerve stimulation: A healthcare professional may use mild electric pulses to stimulate the nerves of the bladder. These can increase blood flow and strengthen the bladder muscles.
  • Bladder retraining: A healthcare professional may teach a person how to retrain their bladder. This involves not going to the toilet as soon as a person feels the urge. Instead, they go at set times, whether they feel the urge or not, and gradually increase the time between toilet breaks.

Will HRT help?

Hormone replacement therapy (HRT) can treat symptoms of perimenopause and may help with OAB and urinary incontinence.

According to a small 2020 study involving 27 females aged 55 and over, participants undergoing estrogen therapy experienced modest improvements in OAB symptoms. Estrogen replaces the hormones that a person’s body stops producing and therefore counteracts the side effects of low hormone levels.

The Food and Drug Administration (FDA) has not directly approved HRT to treat OAB, and there are certain risks associated with HRT. Before prescribing it, a healthcare professional will consider a person’s medical history, family health history, and various other factors.

Low dose estrogen applied directly into the vagina is FDA-approved for genitourinary symptoms related to menopause, such as:

  • the need to urinate more frequently and with increased urgency
  • vaginal dryness
  • atrophic vaginitis
  • dyspareunia or pain during intercourse

There are a number of home treatments and lifestyle changes a person can adopt at home to improve the symptoms of OAB, which include:

  • Bladder control exercises: Kegels are exercises a person can do to strengthen the pelvic floor by squeezing and holding the pelvic floor muscles. “Quick flicks” involve rapidly squeezing and relaxing the pelvic floor muscles repeatedly.
  • Avoiding certain foods and drinks: Some foods and drinks can irritate a person’s bladder and cause them to need to urinate more frequently and with more urgency. People should keep a diary to see which foods and drinks seem to cause them issues and cut back on these items. Examples include:
    • tea
    • coffee
    • citrus fruits
    • tomatoes
    • spicy foods
    • soda drinks
    • chocolate
    • alcohol
  • Maintaining a healthy body mass index: Carrying excess weight can cause pressure on the bladder, which can cause a person to experience OAB. Maintaining a moderate weight can lower a person’s risk of developing OAB.
  • Timed urination: This involves going to the bathroom at set times of day, whether a person needs to go or not. Setting up a timed schedule for bathroom visits can help a person regain control over their bladder.
  • Double voiding: After a person urinates, they can try waiting a few moments before trying again, to ensure their bladder is completely emptied.
  • Delayed voiding: This is the practice of delaying urination for a while, even if a person has the urge to go. They can build up from a few minutes to several hours. It is best to ask a healthcare professional about this method before trying it.

Learn more about measuring BMI for adults, children, and teens here.

Should a person drink less water?

According to the OWH, people with OAB should continue drinking fluids, especially water, to maintain good health. Females need around 11 cups or 91 ounces of fluids every day to keep the kidneys and bladder healthy.

People should speak with a doctor if they notice any worrying changes in their urinary habits. People experiencing perimenopausal symptoms may also have other symptoms they would like to discuss with a doctor.

It is important to speak with a doctor if OAB impacts a person’s day-to-day activities or lowers their quality of life.

The main symptom of menopause is not having a menstrual period for 12 months. Often, people refer to “the menopause” as the transition period leading up to the end of a person’s menstruals cycles. However, true menopause is a point in time 12 months after a person’s last period.

Learn more about the symptoms of menopause here.

The transition period leading up to menopause is known as perimenopause. Various changes can occur in a person’s body during this phase of their life, including:

  • changes in their menstrual cycle, for example length or regularity
  • vaginal dryness
  • irritability
  • anxiety
  • hot flashes
  • fatigue
  • night sweats
  • difficulty falling or staying asleep
  • weakened bones

Everyone’s menopausal transition is different. Some people may experience all of the above, whereas others may only experience a few symptoms. For some, symptoms may be mild, while they may be more severe for others. The duration of the symptoms also varies. Planned Parenthood suggests they can last anywhere between 3—12 years.

OAB is a term that relates to control of the bladder. It impacts as many as 40% of females in the United States. It is not a standard part of getting older, although it is more common as a person ages.

During perimenopause, estrogen levels reduce, causing structures around the pelvic organs to weaken. This can cause a person to experience a sudden urge to urinate and more frequent urination.

Multiple treatment options are available for OAB, including lifestyle changes and prescription medication.

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