Loss of Estrogen with menopause can lead to urinary incontinence and bladder symptoms. The two most common types of urinary incontinence are Stress Urinary Incontinence (SUI), and Urge Urinary Incontinence (UUI).
Atrophy itself doesn’t directly lead to incontinence, but atrophy does increase the likelihood of development and both types of leakage are more symptomatic in the woman with atrophy. Other contributing factors to incontinence include: birth trauma, previous surgery such as hysterectomy, radiation, obesity, repetitive straining (constipation, heavy exercise), medication use, and age.
Review of the medical literature has shown that Estrogen replacement (topical preferred), is beneficial in treating atrophy, particularly symptoms of dryness, itching, burning, pain with intercourse, recurrent UTIs, and urinary urgency and frequency.
The usual dose is 1 gm inserted into the vagina at bedtime between 2-3 times per week. Usually there is a run-in period for 1-2 weeks when first beginning when it is inserted every night or every other night. Of course, any history of breast cancer, cervical or endometrial cancer is clearly contraindicated. Sometimes even vaginal estrogen topical cream can lead to transient flushing, breast tenderness or other symptoms when first starting up. The overall absorption of estrogen into the bloodstream after topical application is inconsequential, and circulating blood levels of Estrogen are unchanged even after 6 months of typical use (1 gram topical every other night). Occasionally it can lead to a burning sensation itself in the vagina, and thus it is not for everyone.
Generally, about 2-12 weeks are needed for resolution of symptoms, however, some women find that once therapy is initiated, it should be continued as long as it is tolerated or desired. Symptoms usually return about 4-6 weeks after it is discontinued. Topical Estrogen alone does not treat stress or urge incontinence, but Estrogen in conjunction with other therapies can improve urge incontinence. Usually, stress incontinence is best treated by a sling procedure once Kegel muscles exercises have failed, or if severe. Lastly, Estrogen therapy is not effective in treating pelvic organ prolapse, such as a dropped bladder (cystocele).