About a decade or so before our final period, a little something called perimenopause starts to make itself known. Typically, perimenopause announces itself with the classic symptoms: irregular menses, mood swings, libido changes, hot flashes—textbook “women of a certain age” stuff. But today, we're here to talk about some of the changes many of us may find unpleasant or even embarrassing to talk about: the ones affecting your bladder. We’re talking pee leaks, frequent nighttime bathroom visits, uncontrollable urgency, and other surprising bladder symptoms that can arrive when perimenopause sets up shop.
To help us better understand what the heck is going on here, we brought in the expert: Dr. Alyssa Dweck, Chief Medical Officer at Bonafide. Bonafide is creating products to fill unmet needs in the area of women’s health, especially focused on quality ingredients found in nature that can benefit women in perimenopause and menopause. Says Dr. Dweck, “The perimenopause and menopause space was, and still is, ripe for disruption and education, especially when many women prefer to or need to avoid hormones or prescription drugs; they need to know about the breadth of management options available.”
Attn: Grace: Folk wisdom about impending menopause prepares us for hot flashes and mood swings, but changes in urinary habits can come as a bit of a surprise. What are some of the ways urinary habits shift during perimenopause?
Dr. Dweck: During perimenopause and more commonly menopause, women can experience uncomfortable symptoms due to changes in the genitourinary tissue, referred to as genitourinary syndrome of menopause (GSM). This updated term replaces the previously recognized term vulvovaginal atrophy (VVA). This newer description suggests that changes due to low estrogen can result in symptoms involving the vulva, vagina, and urinary tract. For example, urinary frequency and urgency are super common symptoms; in fact, urination 8 or more times per day can be categorized as overactive bladder (OAB). Lower estrogen and GSM also predispose one to a higher risk of a urinary tract infection (UTI) during menopause.
AG: So, what can we expect? Will we start to see nighttime bathroom visits? Leaks? More frequency or urgency? If using pads, an increase in absorbency needs?
DD: Some may experience nocturia (urination that occurs during sleep hours). In some cases, this urge to urinate can awaken one from sleep. In other instances, one awakens due to vasomotor symptoms, like night sweats, or for other reasons (i.e. anxiety, a busy mind), and incidentally also needs to urinate. OAB symptoms, including frequency and urgency, may be more common during perimenopause and menopause sheerly due to age or other factors. Leaks might be due to OAB, stress incontinence, medical issues, medications, an infection, or a combination of factors.
AG: It sounds like there are a lot of different ways that leaks and urinary symptoms can manifest during perimenopause. What would be considered not normal?
DD: Any symptom that causes distress, an interruption of day-to-day activities, or sleep disruption should be addressed. For sure, any urgency or frequency associated with fever, pain, hematuria, or flank pain, needs evaluation by a healthcare provider.
I also want to point out that women should carefully consider not only managing symptoms that are distressing, but also taking proactive steps to prevent future symptoms. For example, hot flashes and night sweats, otherwise known as vasomotor symptoms, are often disruptive to day-to-day activities and sleep, and can last, on average, for 7.4 years. Suffering is just not acceptable when relief is available, whether that be hormonal or hormone free, or drug or non-drug.
AG: If a woman is noticing bladder leaks or other changes, what can she do?
DD: Once medical issues are ruled out, one can try lifestyle interventions to address any disruptive changes. In the case of bladder leaks, these might include elimination or moderation of caffeine or alcohol, both of which can irritate the bladder. Timed voiding, when one urinates on the clock, regularly during waking hours, whether they have an urge or not, can help to train the bladder. Moderating and timing hydration can also be beneficial. Pelvic floor physical therapy, including kegel exercises, can be helpful for some. Finally, local vaginal estrogen can be helpful for both prevention of UTI and mitigation of bothersome urinary symptoms.
[Editor’s note: High-quality bladder leak products can provide essential comfort even if leaks are short-lived.]
AG: How long can we expect to have to live with this? After menopause, are we out of the woods, and can we expect things to stabilize?
DD: Management of urinary symptoms, particularly with the use of local vaginal estrogen, is recommended regularly. Lifestyle modification measures should also be ongoing. These interventions can help keep symptoms controlled. Some people do resort to urologic intervention, including surgical and device-related options, when warranted.
AG: What do women in their peri/menopausal years need to consider when selecting products to manage any of their symptoms, including and beyond urinary symptoms?
DD: Broadly, one needs to consider hormonal vs. hormone-free management options based on individual medical history and personal preference. Choosing a drug or non-drug option is another important decision, which is based on preference, access, coverage, and side effect/safety profile. Ingredients need to be carefully considered and vetted. Finally, science-backed, well-researched products, including supplements, might be considered.
At Bonafide, we invest millions into research and development, annually, with studies done specifically in menopausal women, to ensure these products are safe and effective in the women for whom they are intended.
AG: Any parting thoughts on how we can better care for ourselves as we go through perimenopause and menopause, with or without leaks or any of the many ailments that can rear their heads at this time?
DD: It helps to bear in mind that there is no one-size-fits-all solution for menopausal symptoms. Misinformation, specifically in the menopause space, is still promoted and research in women is still lagging. On the other hand, access to women’s midlife care is available but there is plenty of room for improvement here as well.
Perimenopause may come with surprising changes, even to your bladder, but that doesn’t mean you should grin and bear it. As Dr. Dweck reminds us, support, education, and effective solutions do exist, whether you're managing leaks, hot flashes, or just feeling off. That’s why we’re big advocates for talking about the things that others don’t want to discuss: to help us all remember that our womanhood is not something to be suffered through.
To shop Bonafide’s hormone-free, clinically studied menopause symptom solutions, head to their store and use promo code GRACE20 for 20% off your first subscription order of their hormone-free supplements, serums, and systems.