Beyond Hot Flashes: How Perimenopause Can Affect Urinary and Sexual Health
On any given day, an estimated 2 million U.S. women enter a life-changing phase called perimenopause. For many, this transition from regular menstruation to menopause feels beyond their control, bringing unpleasant symptoms that trigger confusion and dread.
Yet if more women could anticipate and understand how perimenopause is changing their bodies, and why, they can gain a good measure of control.
For instance, some women might not realize that the hormonal changes they undergo during perimenopause alter not just their moods, menstrual cycles, and complexions. These shifts also might interfere with a woman’s urinary and sexual health, including her ability to “hold it in” and enjoy pain-free intimacy.
That perimenopause typically occurs when a woman isn’t expecting it – usually in her mid-40s – makes this curve ball harder to catch. But you can get ahead of perimenopause, or meet it in its path, with the guidance of physicians dedicated to women’s health.
What Exactly Is Perimenopause Doing to My Body?
Perimenopause is not a condition or disorder; it is a natural stage in a woman’s life when her body slows down the processes that enable pregnancy.
After prime childbearing years, a woman’s ovaries gradually produce less of the female hormones estrogen and progesterone, which regulate the release of eggs and menstruation. Over time, her menstrual cycle becomes irregular, then infrequent, until it ends.
After a woman has experienced 12 consecutive months without a menstrual cycle, she has entered menopause. The average age is 52.
Until then, the fluctuation of female hormones can cause side effects such as mood swings, brain fog (including forgetfulness), weight gain, and urinary and vaginal problems.
Specific symptoms of perimenopause include:
- Hot flashes and night sweats
- Trouble concentrating
- Bone loss
- Longer periods of bleeding
- Breast tenderness
- Changes in sexual desire
- Vaginal dryness (painful sex)
- Leaking urine when you sneeze or cough
- The urgent need to urinate, and more frequently.
Most women do not seek care for perimenopause symptoms, research shows, perhaps because they are gradual and can be blindsiding. But perimenopause’s effects, including on urinary and sexual wellness, can be treated.
Interested in learning more? You can access a replay of our webinar about menopause here.
How Perimenopause Disrupts Urinary Tract and Sexual Health
Female hormones regulate more than a woman’s menstrual cycle. They also supports bladder function and vaginal lubrication. Because these parts of your body are physically close to your sexual and reproductive system, disorders with one area can affect the other.
Among the conditions our female health physicians discuss and treat regularly:
Pelvic floor disorders – The pelvic floor consists of a tight network of muscles and connective tissue that hold several organs in place, including the upper vagina, bladder, uterus, and rectum. Declining estrogen levels can cause the pelvic floor to weaken, enabling these organs to slip and bulge, or prolapse, into the vaginal canal. Up to half of all women develop pelvic organ prolapse over their lifetimes. Read about pelvic prolapse treatments here.
Incontinence – Defined as an urgent and hard-to-control need to pee, incontinence occurs in twice as many women than men, due in part to hormonal changes. It can develop in two forms:
Stress incontinence – Involuntary urine leakage forced by sudden movements that add pressure to your abdomen, such as coughing, laughing, or jumping. A weak pelvic floor, including a weak urethra, are factors.
Urge incontinence – Leakage following an immediate, hasty need to pee. It also is referred to as overactive bladder (OAB) because it can stem from a miscommunication of the nerves that signal the brain to empty the bladder. Read more of our overview of urinary incontinence.
Vaginal dryness – Because the hormones that lubricate the vagina begin to decline during perimenopause, the vaginal tissue starts becoming thinner, dryer, and less flexible. This can cause painful friction during intercourse that can worsen if sex is avoided (due to atrophy). Learn how painful intercourse can be treated.
Recurrent bladder infections – When bacteria enter the urinary tract and reach the bladder, they cause a painful, burning infection. Drops in hormone levels can make women more susceptible to recurrent bladder infections because the resulting dryness disrupts the vaginal microbiome, which helps fight infection. Visit our web page on urinary tract infections here.
Pelvic pain – An imbalance of female hormones also can lead to a thinner, drier bladder lining because estrogen preserves the thickness and elasticity of the tissue. Estrogen also activates the mast cells, which release histamine to fight inflammation. Therefore, when estrogen declines, bladder tissue might become prone to inflammation and a condition called interstitial cystitis, or painful bladder syndrome. Interstitial cystitis explained, here.
How You and Your Care Team Can Ease Perimenopausal Symptoms
You are not alone in experiencing symptoms of perimenopause, and will likely find many other women – including potentially your doctor – have or had also experienced the signs. Once you open up about it, you should start to feel relief.
Key treatments for perimenopausal symptoms include:
Hormone therapy – Several forms of hormone-replacement therapies can help rebalance a perimenopausal woman’s estrogen, progesterone, and testosterone levels and reduce symptoms such as low libido, sexual dryness, and hot flashes. Ask your doctor about options, which include self-applied creams, pills, and patches.
Stimulated collagen production – For painful intercourse, we offer an outpatient treatment called MonaLisa Touch, which painlessly directs lasers to the vaginal tissue and stimulates collagen production, for better lubrication. Read details about how MonaLisa Touch works here.
Meet Our Women’s Urinary and Sexual Wellness Team
The Urology Group is building our team of professionals dedicated to the medical field of women’s urogynecological health. We’d like you to meet them.
- Susan Oakley, MD, FACOG, URPS
- Rebecca Roedersheimer, MD
- Anne Scott, MD
- Brian Shay, MD
- Daniel Szabo, MD
These specialists are aided by a suite of physician assistants, nurses, and fellow urologists. They are here not only to treat the side effects of perimenopause and other uniquely female urinary and sexual issues, but also to counsel and comfort you.
To request an appointment to talk to a physician, click here.
About the Author
