INCONTINENCE AND THE
MENOPAUSE
Problems of the urinary tract which so often trouble women after the
menopause are not just uncomfortable they can also be thoroughly embarrassing.
Urinary incontinence is the most common, shown in some studies to affect as
many as half of all women at some time after the menopause.
Urinary incontinence is not the only urogenital complaint to trouble women
in their middle years. Vaginal discomfort and infections in the lower urinary
tract (such as cystitis) are both much more common after the menopause than
before. However, incontinence is the most common problem, and the one which can
cause greatest distress studies show that around one in ten 50 year old women
and many more older women are affected to some extent. Sometimes, they have a
sudden urge, sometimes they feel like going all the time, but most often they
leak urine as a result of stress sudden muscular pressure on the bladder which
might come from laughing, sneezing or exercise.
And the menopause is one reason why the whole fabric of muscles which keep
the bladder closed becomes weaker.
The menopause
The menopause is actually that brief time when a women's reproductive life
comes t an end. It's the time when the ovaries stop producing eggs, and when
release of the hormone oestrogen comes to end. This change of life is marked by
the end of menstrual periods.
The symptoms which many suffer at the menopause are primarily a result of
oestrogen deficiency. They may be short term like hot flushes and night sweats
or long term like osteoporosis they may be psychological or more localised,
like incontinence and vaginal infections. But whatever their nature, doctors
seem now agreed that such symptoms justify treatment.
Hormone replacement therapy
Because incontinence and other vaginal problems after the menopause are
certainly related to changing hormone levels, hormone replacement therapy,
which replaces the body's lost oestrogen, has been shown to help incontinence
and prevent the symptoms of some urinary tract infections.
All kinds of HRT tablets, skin patches, and implant might be prescribed.
Women who have had a hysterectomy normally need no other hormone but oestrogen,
however, women who still have a womb must take a short course of progestrogen
each month. This will cause a return to monthly periods.
The very latest forms of HRT combine the effects of oestrogen and
progestrogen in a single tablet without the need for monthly bleeding.
Not all women are suitable for HRT and doctors can offer advice about this.
However, women considering HRT to prevent urinary tract problems often find
that their doctors recommend a course of a mild natural oestrogen which comes
in the form of a tablet.
Oestrogen cream, which is applied with an applicator to the affected site,
might help control symptoms as well as vaginal dryness and will not cause many
of the side effects which some women find with other forms of HRT.
However, because their effect is local, oestrogen creams will not offer any
of the long term benefits associated with other HRTs such as protection against
heart disease and osteoporosis.
Who can help?
HRT is a prescription medicine and can only be prescribed by a doctor.
GPs and doctors at well women and family planning clinics are now well
experienced in treating all problems associated with the menopause. Your
medical history and a few checks will indicate if you are suitable for HRT.
Several health centres and hospital departments have now set up specialist
menopause clinics, which can offer advice in more difficult cases.
The following organisations might also be useful for information.
Women's Health Concern
83 Earl's Court Road
London
W8 6EF
Amarant Trust
56 Britton Street
London
EC1M 5NA
The Continence Foundation
2 Doughty Street
London
WC1N 2PH
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