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Urinary incontinence and menopause

Urinary incontinence (UI), those sudden bladder leaks, is a common menopausal symptom for many women. But are those leaks really due to menopause? Or does UI merely take place at the same time menopause does, without being directly caused by menopause? Recent findings from a long-term study conducted in the United Kingdom are helping to clarify the mysteries of menopause while learning more about women’s health issues and the aging process.

Urinary incontinence and menopause
There are three types of UI. Stress UI refers to the little bladder leaks due to coughing, sneezing, laughing, or lifting. Urge UI is when the bladder muscles do not respond as they should; those muscles release urine at the wrong times. Server UI means frequent (twice a month or more) urge UI episodes.

Healthcare professionals have long associated UI with declining estrogen levels during menopause and perimenopause. The North American Menopause Society’s July 27, 2010 email newsletter ‘First to Know’ describes how estrogen may not be the only reason for those bladder leaks, and that menopause does not automatically mean suffering with UI.

Menopausal transition and the risk of urinary incontinence
A team of researchers in the UK has been following 1,211 women to learn more about UI and menopause. The women selected were all born in 1946, and each woman has been examined every year from the age of 48 to 54 or the time when most women are deemed menopausal or perimenopausal.

Among the most significant discoveries:
*Stress UI symptoms were more common in women who were perimenopausal for at least one year
*Postmenopausal women (more than 12 months since their last menstrual period) were least likely to experience stress UI
*Stress UI was more likely linked to declining estrogen levels during menopause, compared to urge UI or severe UI which both were due more to the aging process and not hormonal imbalance

Estrogen and urinary incontinence
Estrogen has not been officially ruled out as a contributing factor of UI during menopause. But the researchers behind this study emphasize that in the past stress UI was easily listed as a menopausal or perimenopausal symptom and explained away due to deceased estrogen levels. But long-term studies such as this one point out that during the postmenopausal years when estrogen levels are at their lowest, stress UI occurs less frequently.

Keep in mind that both urge UI and severe UI do happen more in advanced age but these conditions are more likely caused by weakened muscles rather than hormones outright.

What does all this mean for menopausal women?
Previously there were few results from long-term studies of women’s health issued including menopause. With more research being devoted to learning about menopause it is increasingly evident that menopause is not always the automatic cause behind various health issues such as urinary incontinence.

Dr. Christiane Northrup has referred to menopause treatments in the past as a one-size solution for all women. Women were usually given the same hormone replacement therapy (HRT) treatments simply because they were menopausal, regardless of individual symptoms. Dr. Northrup has suggested a better approach is in a type of ‘recipe’ treatment where each woman is given the correct mix of HRT that will deal with her own unique set of symptoms.

This shows the importance of long-term studies for menopause. Women and healthcare professionals no longer view menopause as the culprit behind every health issue. Understanding more about what happens to women’s bodies during and beyond menopause helps separate the myths from the facts.

Referring to those bladder leaks, if estrogen levels are to blame then proper HRT treatment can be prescribed for particular women. But if for some women their UI is not directly linked to estrogen levels there may be more suitable treatment options available rather than the old standby.

At times this may leave women more confused after reading yet another latest breakthrough. But the good news is that as more research is done the better women’s health issues including menopause are understood.

L. Elaine Waetjen, MD, appearing in NAMS First to Know release of July 27, 2010

Mishra GD, Cardozo L, Kuh D. Menopausal transition and the risk of urinary incontinence: results for a British cohort study BJU Int 2010 Mar 15

Waetjean LE, Ye J, Feng WY, et al. Association between menopausal transition and the development of urinary incontinence Obstet Gynecol 2009: 114:989-998

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