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Understanding the Link Between Incontinence and Menopause

Menopause is a natural stage in your life that signifies the end of your fertility. While this transition brings about several hormonal changes and symptoms, one lesser-discussed issue that affects many women during menopause is urinary incontinence. 

Our team of doctors and certified nurse midwives at Westover Hills Women’s Health help women navigate through menopause here in San Antonio, Texas, so if you’re dealing with any symptoms of menopause, we encourage you to visit us.

In the meantime, let’s explore the link between incontinence and menopause. 

What is menopause?

Menopause typically occurs in women between the ages of 45 and 55, with the average age around 51. It’s defined as the natural cessation of menstruation due to a decrease in the production of hormones like estrogen and progesterone by the ovaries. 

Menopause is the end of a woman's fertility and is marked as 12 consecutive months without a period, but you might experience symptoms for months or even years before you reach that 12-month milestone. This in-between time is known as perimenopause. 

Menopause can also be surgically induced. If you have a hysterectomy, the removal of your uterus triggers menopause even if you aren’t near the average age of menopause. This is known as induced menopause.

Types of urinary incontinence

Urinary incontinence is a condition characterized by the unintentional leakage of urine. There are several types of urinary incontinence, but two primary forms are closely associated with menopause:

Stress incontinence

This type of incontinence occurs when physical activities such as laughing, sneezing, coughing, or exercising put pressure on your bladder, causing leakage. It is often linked to the weakening of pelvic floor muscles, which can happen due to hormonal changes during menopause.

Urge incontinence

Also known as overactive bladder, urge incontinence involves a sudden, intense urge to urinate, which may lead to leakage before you reach the restroom. Menopause-related hormonal shifts can irritate the bladder and contribute to this condition.

How menopause affects your bladder

The hormonal changes that occur during menopause can affect your bladder and surrounding tissues in several ways.

Estrogen decline

Estrogen plays a crucial role in maintaining the health of your urinary tract. Reduced estrogen levels during menopause can lead to thinning of the vaginal walls and weakening of the pelvic floor muscles, both of which support your bladder and urethra.

Urogenital atrophy

The decrease in estrogen levels can cause urogenital atrophy, leading to dryness, irritation, and thinning of the vaginal tissues. This can contribute to discomfort and increase the risk of urinary tract infections (UTIs).

Bladder irritability

Changes in hormone levels can make your bladder more sensitive and prone to irritation, resulting in symptoms like urgency and frequent urination.

Managing incontinence during menopause

While menopause-related incontinence can be challenging, there are several strategies to manage and alleviate its symptoms.

Pelvic floor exercises

Practicing Kegel exercises can strengthen your pelvic floor muscles, reducing stress incontinence.

Lifestyle modifications

Maintaining a healthy weight, avoiding bladder irritants (like caffeine and alcohol), and staying hydrated can all contribute to better bladder control.

Hormone replacement therapy

In some cases, our Westover Hills Women’s Health team may recommend HRT to alleviate menopause symptoms, including incontinence. This may be ideal if you’re experiencing other symptoms of menopause such as hot flashes, night sweats, and mood swings.


There are medications available to treat urge incontinence. These include topical estrogen, alpha blockers, mirabegron, and anticholinergics. 

Lifestyle modifications 

Techniques such as bladder training and scheduling can improve control over urination. You might also consider lifestyle modifications such as:

You may find that lifestyle modifications alone aren’t enough to fully resolve incontinence. Keep a diary of your symptoms, any triggers that make incontinence worse, and the severity of your symptoms.

Surgical options

In severe cases, we may recommend a surgical procedure to address incontinence, but this is typically a last resort. If surgery is right for you, Houmam Al-Hakeem, MD, performs gynecologic robotic-assisted surgery.

Get help for menopause and incontinence

If you are experiencing incontinence symptoms during menopause, don't hesitate to discuss your concerns with us. We know it’s not always easy to talk about urine leaks, but there are treatment options available to help you regain control and enjoy a better quality of life during this transformative phase. 

To speak with our compassionate staff, call one of our San Antonio, Texas, offices. You can also use our online tool to book your next appointment.

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