Today I’d like to take a closer look at the role of hormones on bladder health. Hormones have been known for a while to play a role in lower urinary tract symptoms such as UTIs, interstitial cystitis and stress incontinence. Hormones may be the reason why women generally seem to be more prone to bladder problems than men and also why some symptoms may get worse at certain times of the month.
The female genital tract and the lower urinary tract are made from the same embryological tissue. Therefore, both are sensitive to the effects of female sex hormones throughout life.
There are receptors (docking stations) for oestrogen and progesterone in the vagina, bladder, urethra and pelvic floor musculature .
Oestrogen especially is known to play an important role in the urinary tract, although the role of other hormones have not been defined clearly.
For example, changes in oestrogen levels after menopause have been associated with symptoms such as urinary frequency, nocturia (frequently having to get up at night to go to the toilet), urgency incontinence and recurrent UTIs as well as vaginal symptoms such as dryness, burning and itching .
The two main female hormones are oestrogen and progesterone.
Oestrogen is the main hormone in the first half of the cycle, when the female body is preparing for ovulation and conception.
The second half of the cycle after ovulation and before menstruation is dominated by progesterone, which helps the body start pregnancy in case of conception.
Luteinizing and follicle stimulating hormones are two other important players in this hormonal ‘dance’.
Small amounts of testosterone are also important to help with (sex) drive and muscle integrity.
After menopause, the body produces a lot less oestrogen and testosterone production also tends to decrease.
Oestrogen and Urinary Tract Infections
The incidence of UTIs often seems to rise after menopause. Among other influences, low oestrogen levels may induce structural and chemical changes in the urinary tract that increase the likelihood of catching an UTI .
Firstly, oestrogen seems to influence the microbiome. This has been documented in the vagina  but has not quite been established for the bladder. However, we now know that the bladder is not sterile but has its own micro flora, so there is reason to believe that this could also be influenced by oestrogen. Oestrogen may help friendly Lactobacilli bacteria to establish themselves in the vagina, helping to protect the bladder from invasion .
Oestrogen also influences immune cells and the release of anti-microbial chemicals in the bladder and may therefore play a role in how effectively an infection is warded off .
Oestrogen has been found to strengthen urinary tissue by tightening the top layer of cells, which protects the underlying cells from infection .
One defence mechanism of the body is to shed cells on top of the bladder tissue in case they have been infected. This may make the underlying cells more susceptible to infection. Oestrogen may help to better connect cells and prevent excessive shedding .
On the other hand, higher amounts of oestrogen may make it easier for pathogens to invade bladder cells, which may be the reason why a lot of young women are also highly susceptible to UTIs .
Oestrogen and Interstitial Cystitis
Many cases of interstitial cystitis have a high mast cell count. Mast cells in the bladder have been found to have receptors with a high affinity for oestrogen .
Mast cells activation (the release of inflammatory chemicals from mast cells) can play a role in IC flares. Interestingly, bladder mast cell activation can be increased by oestrogen .
Hormonal manipulation has been shown to improve IC symptoms in at least one study .
These findings may explain why IC symptoms often worsen before menstruation [5, 6].
Hormones and Incontinence
Oestrogen plays an important role on the continence mechanism in the bladder. This may be because it helps to raise the sensory threshold in the bladder (i.e. the point at which the bladder has to be voided is higher). It may also increase the resistance of the urethra (bladder opening) and affect the bladder muscle .
Recently it has also been shown that testosterone plays and important role in maintaining continence. Testosterone levels also often decline with age.
This may be because testosterone has an anabolic (building) effect on muscles and specifically it helps to maintain pelvic floor muscle strength. Maintaining pelvic floor strength is important for reducing the chance of incontinence .
So as we can see, hormones may play an important role in lower urinary tract symptoms and this connection may explain why these symptoms occur more in women and also why some symptoms can fluctuate throughout the cycle.
Now I’d like to hear from you: Have you notice increased bladder issues after hormonal changes? Let me know in the comments!
Pin it for later:
- Robinson, D. et al The effect of hormones on the lower urinary tract. Menopause Int. 2013 Dec;19(4):155-62 https://www.ncbi.nlm.nih.gov/pubmed/24336244
- Lüthje, P. Estrogenic action on innate defense mechanisms in the urinary tract. Maturitas. 2014 Jan;77(1):32-6. doi: 10.1016/j.maturitas.2013.10.018. Epub 2013 Nov 5. https://www.ncbi.nlm.nih.gov/pubmed/24296328
- Silva, C. et al Effects of estrogen administration on the colonization capability of lactobacilli and Escherichia coli in the urinary tracts of mice. Methods Mol Biol. 2004;268:387-399. https://www.ncbi.nlm.nih.gov/pubmed/15156049
- Bahar Gholipour How Estrogen Fights Urinary Tract Infections Live Science June 19, 2013 https://www.livescience.com/37563-uti-estrogen-menopause.html?utm_source=Twitter&utm_medium=social&utm_campaign=CystitisInfo&utm_content=Menopause
- Pang et al Bladder mast cell expression of high affinity oestrogen receptors in patients with interstitial cystitis BJUI Volume 75, Issue 2 February 1995 Pages 154–161 http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.1995.tb07303.x/full
- ConstantineSpanos et al Carbachol-induced bladder mast cell activation: Augmentation by estradiol and implications for interstitial cystitis Urology Volume 48, Issue 5, November 1996, Pages 809-816 http://www.sciencedirect.com/science/article/pii/S0090429596002397
- Lentz GM et al Hormonal manipulation in women with chronic, cyclic irritable bladder symptoms and pelvic pain. Am J Obstet Gynecol. 2002 Jun;186(6):1268-71; discussion 1271-3. https://www.ncbi.nlm.nih.gov/pubmed/12066108
- Jody A. Charnow Low Testosterone Increases Women’s Urinary Incontinence Risk Renal and Urology News May 14, 2017 http://www.renalandurologynews.com/aua-2017-annual-meeting/low-t-ups-ui-risk-in-women/article/661477/?platform=hootsuite
Claire Saul (PainPalsBlog)July 10, 2017
Hi Layla, Great article! I have posted your link on Pain Pals regular feature Monday Magic – Inspiring Blogs for You! Claire x
LaylaJuly 10, 2017
Thank you, Claire!
landscapedzinerAugust 5, 2017
YES I have noticed major issues with urinary incontience since becoming full menopausal. I started out on bio identical hormone cream with testosterone, estrogen and progesterone, it seemed to lessn the incontinence however I had to switch to another doctor and insurance wouldnt pay for testosterone at this point so only getting progesterone and estrogen and I’m noticing a big increase in the urinary incontinence now!!! Glad you brought this up, many women may not even know that, I didnt even connect the dots until just now myself! Testosterone also helps bone strength, as do the other hormones, and I believe its definitely necessary for women who are menopausal now!
LaylaAugust 5, 2017
Thanks for sharing this! I think many women are unaware of the importance of testosterone, especially after menopause!
Tammie GreenAugust 25, 2021
I’ve been feeling bad for 2 weeks with worse overactive bladder., tired, Pain in my lower abs which is also my whole pelvic area and sometimes top of thighs. The past year I have battled feeling I pulled my groin plus battle rectal pressure . But now wondering what’s going on with it all hitting me. I can’t hardly left anything now without paying for it. (Strain feeling down low) my past is 2011 absolute total hysterectomy. I had an ablation a year before but it made my pain and bleeding worse for some weird reason. I have fibro on top of all and I’m getting so frustrated
NicDecember 20, 2017
I’ve started tracking my cycles using hormone horoscope. I suffer from recurring bouts of cystitis every few weeks. I’m clean, I have good hygiene and it just seems to occur for no reason. Well here i am, feeling pretty sorry for myself today, noticed my period isn’t far off and checked my hormone horoscope app and sure enough I’ve just experienced the oestrogen plummet, which is linked to less mucous and thinning of the cell walls making them susceptible to damage. Going to keep track of these bouts and see if they really are linked to that. In a way I’m hoping I’m wrong cos menopause will be a nightmare.
MelDecember 27, 2017
I have noticed the link between hormones and an inflammed bladder. I have been peri-menopausal for many years and suffered badly with cystitis and an inflammed bladder. I changed my diet and cut out completely citrus fruits, dairy, wheat, potato family, spices, alcohol etc all the things I know I have had intolerances to over the years and had to cut out before because of symptoms of cystitis, and the symptoms seemed to lessen over time and then completely. But recently further along the peri-menopause I have started to have severe backache and a slightly inflamed bladder for one day which has gone by the evening. Every so many months I think I know my cycle but then it changes again. I have now missed my first period and coming up to my next and had the backache and bladder problem a few days before it was due. So I do believe it is hormone related but from experience know it can be helped through diet.
LaylaDecember 27, 2017
I have a post about the bladder-back connection that might be worth checking out – there is a connection between the nerves in the spine and the bladder. But of course hormones can also play a role.
J SmithJanuary 18, 2018
I was diagnosed with IC and my problem is always feeling like I have to pee within 45 min of going. I have been doing acupuncture for this and it has helped some. Will this just go away on its own once my hormones regulate? I am 62 yrs old. Would I benefit from bioidentical hormones? I was using estriol cream for a year but then it was making me highly emotional.
SeaJune 11, 2018
I’m 49 and believe I’m pre menopausal. I feel heat sensations and bladder pressure below when I’m lying down at night. It make me have to get up and pee and is uncomfortable. I accidentally found I get relief by taking 2 ibuprofen tablets. This happens mostly a day to a week after a period and lasts one to several days.
DianaSeptember 4, 2018
Thank you for summing these studies up! I also noticed my IC pain varies with my cycle. I am 43 and my periods have become shorter and lighter on average and I get a lot of headaches, esp the few days before my period. Is there any way to test hormones to get sense of what imbalance I need to treat? I was told by my GP that hormones vary so much, even during one day, that blood tests are not reliable. So, while I can tell hormones play a role, I have no clue how to determine which role and how to address them. I’ve never taken birth control pills and feel apprehensive about just doing a trial and error with birth control.
LaylaSeptember 7, 2018
Your GP is right, it’s hard to get an accurate test on hormones because of monthly fluctuations. One test that I have used in the past is the DUTCH dried urine test – basically you take several samples on a particular day of the month. The only downside is that you’d have to pay for it privately and it’s not cheap!
MargaretMarch 14, 2021
I am a 59 year old woman. I sto stopped menstruating at 58 years old. I am taking bioidentical hormones because of osteoporosis it’s a cream that I rub on my arm. I’ve noticed cystitis/burning pain in the urethra. I don’t have a UTI. I get flares every 4 days and this has been going on for as long as I’ve been using the cream. I am on a low carb diet have no other issues eccept for this debilitating pain. Could the estrogen be the culprit?
LaylaMarch 16, 2021
It’s hard to say from a difference but if it started at the same time then it would make sense. Hormones can certainly play a role in urinary issues. Have you spoken to your doctor about this?