Link Between Perimenopause and Overactive Bladder, plus Treatment Options
In the transition period leading up to menopause, known as perimenopause, many women may experience a variety of symptoms, including changes in urinary habits. One such condition is Overactive Bladder (OAB), characterised by urgency incontinence. This article explores the causes, symptoms, and treatment options for OAB during perimenopause.
OAB is a group of symptoms related to the control of the bladder, and it can affect as many as 40% of females in the United States. During perimenopause, hormone levels begin to change, and low estrogen levels can weaken the bladder and urethra, leading to OAB and urinary incontinence. Symptoms may include a strong and sudden urge to urinate immediately, needing to urinate overnight, urinating more than eight times in 24 hours, and feeling the need to leak urine if not going to the bathroom immediately.
Fortunately, several treatment options are available for women experiencing OAB during perimenopause. Common treatment options include pelvic floor physical therapy, medications, minimally invasive procedures like Botox injections, nerve stimulation, hormone therapy, and lifestyle modifications.
Pelvic floor physical therapy focuses on strengthening and rehabilitating pelvic muscles to improve bladder control and reduce urgency and incontinence symptoms. Devices such as VTone use gentle electrical muscle stimulation to tone pelvic floor muscles and can be particularly helpful for mild to moderate symptoms during perimenopause.
Medications commonly prescribed are anticholinergics and beta-3 agonists such as tolterodine, trospium, and mirabegron, which calm bladder muscle overactivity to reduce urgency and leakage, though they may cause side effects like dry mouth or constipation.
Minimally invasive options include Botox injections into the bladder muscle, which temporarily reduce spasms and symptoms for 6 to 9 months, requiring repeat treatments. Percutaneous tibial nerve stimulation, a nerve modulation technique using a needle near the leg, can also reduce frequency and urgency in some cases.
For women in perimenopause, declining estrogen contributes to urinary symptoms; thus, local or systemic hormone therapy with bio-identical estrogen pellets or topical estrogen can improve urinary tract tissue health and function. However, it's important to note that the FDA has not directly approved HRT to treat OAB, and there are certain risks associated with HRT.
Lifestyle modifications such as weight management, limiting caffeine and alcohol, and scheduling bathroom breaks complement these treatments. People with OAB should continue drinking fluids, especially water, to maintain good health.
A small study found that participants undergoing estrogen therapy experienced modest improvements in OAB symptoms. HRT can treat symptoms of perimenopause and may help with OAB and urinary incontinence. However, it's crucial for anyone noticing any worrying changes in their urinary habits, if OAB impacts their day-to-day activities, or lowers their quality of life, to speak with a doctor.
In conclusion, treatment for OAB during perimenopause is tailored to symptom severity and individual patient preferences, often combining pelvic floor rehabilitation, medications, hormone therapy, and minimally invasive interventions for best results. If conservative and minimally invasive measures fail to provide adequate relief, more advanced surgical options may be considered.
- Overactive Bladder (OAB) affects about 40% of females in the United States, particularly during perimenopause due to low estrogen levels that weaken the bladder and urethra.
- Pelvic floor physical therapy is a common treatment for OAB during perimenopause, focusing on strengthening and rehabilitating pelvic muscles to improve bladder control and reduce symptoms.
- Medications like anticholinergics and beta-3 agonists are often prescribed to calm bladder muscle overactivity and reduce urgency and leakage, despite potential side effects like dry mouth or constipation.
- Minimally invasive options, such as Botox injections and percutaneous tibial nerve stimulation, can temporarily reduce spasms and symptoms for those with OAB during perimenopause.
- For women in perimenopause, hormone therapy with bio-identical estrogen pellets or topical estrogen can improve urinary tract tissue health and function, though there are risks associated with its use and it may not be directly approved by the FDA to treat OAB.
