Low estrogen can cause changes to the bladder and genitals. It may lead to more frequent urination, pain during sex, vaginal dryness, and other symptoms. Treatment options range from hormonal therapy to dietary changes.

Estrogen levels decline during menopause. However, they can also drop during other stages of life, such as after giving birth or while breastfeeding.

However, not all people with low estrogen develop bladder issues. Likewise, it can also occur for other reasons. For example, people who have previously given birth may have pelvic floor dysfunction.

In this article, we will explore low estrogen bladder symptoms, what can cause them, diagnosis, and treatment.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Low estrogen can cause thinning of the tissue that lines the genitals. Doctors call this genitourinary syndrome of menopause (GSM). GSM may cause:

Some degree of GSM is very common after menopause. A 2020 study estimates that 50–70% of postmenopausal women have at least some of the symptoms. The severity varies from person to person, though, and not all people need treatment.

Low estrogen can also affect people outside of menopause, especially after giving birth or during breastfeeding. As many as 15% of premenopausal females may have GSM-like symptoms for this reason.

Some bladder symptoms that can occur due to low estrogen include:

  • Incontinence: This means that a person loses control of their bladder. This can happen in any context. However, one of the most common forms is stress incontinence. This means that a person loses control of the bladder when there is pressure on the pelvic floor, such as when coughing, running, or laughing.
  • Urinary pain: A person may have pain when urinating or shortly before or after. Some people notice that their bladder feels painful or full after urinating or that they are unable to fully empty their bladder.
  • Overactive bladder (OAB): A person may urinate more frequently than usual or have difficulty holding their bladder when they need to use the bathroom.

A person with low estrogen may have genital symptoms, too, such as:

Low estrogen can cause bladder symptoms by thinning the tissue that lines the vagina. This decreases the elasticity and strength of the vagina and surrounding muscles, reducing muscle support for the bladder and related structures, such as the urethra.

However, GSM-like symptoms can appear for other reasons, too. Both menopause and recent childbirth correlate with a higher risk of other issues that may cause bladder issues, such as pelvic floor injuries.

Other potential causes include:

  • pelvic organ prolapse, which can obstruct the urethra and cause problems with urination
  • nerve damage and disorders of the nervous system
  • spinal cord injuries
  • obesity, since obesity puts extra weight on the pelvic structures
  • pregnancy and breastfeeding
  • medications side effects

If a doctor suspects a person’s bladder symptoms are related to menopause, they will take a person’s medical history and perform a physical examination to look for signs of GSM. Laboratory tests are usually not necessary for a diagnosis. However, doctors may occasionally use:

  • vaginal pH testing
  • vaginal culture to assess the health of the microbiome
  • vaginal maturation index, which assesses if cells in the vagina lack estrogen
  • tissue biopsy, in cases where treatment does not improve the symptoms

If it is unlikely the symptoms are related to menopause, a doctor may perform other tests to rule out other conditions, such as UTIs. They may also assess someone’s hormone levels, bladder function, or nerve function.

A number of treatments may help with symptoms. They include:

  • Hormone replacement therapy (HRT): For GSM or vaginal atrophy, a doctor may recommend HRT to replace lost estrogen. This may involve topical creams, oral tablets, or patches that stick to the skin.
  • Pessary: This device can help support the pelvic organs, relieving pain and some bladder symptoms.
  • Physical therapy: Physical therapy may help restore pelvic floor function and strengthen the muscles. A physical therapist may recommend pelvic floor exercises, such as Kegels, as well as exercises to strengthen the core.
  • Changing urination habits: Some simple changes to urination habits may help reduce instances of incontinence. For example, those with stress incontinence can urinate before exercise or sex.
  • Other medications: There are additional medications for those with OAB, such as anticholinergics and beta-3 agonists, which relax muscle spasms in the bladder.
  • Diet and lifestyle changes: Maintaining a moderate weight, getting regular exercise, and similar strategies can help reduce pressure on the pelvic muscles, potentially easing symptoms. Some may find it helpful to avoid alcohol and caffeine.
  • Surgery: Surgery may help with urinary incontinence or pelvic organ prolapse when other interventions do not help.

Changes to the vagina and genitals are common when a person has low estrogen. After menopause, these changes may be permanent. This does not mean that a person will always experience bladder pain or dysfunction, though.

Some strategies for coping include:

  • Finding a knowledgeable doctor: It is important to find a medical professional who is knowledgeable about bladder health and who takes symptoms seriously.
  • Getting a diagnosis: This may be necessary to get insurance to cover care, and to find an effective treatment.
  • Joining a support group: People who have dealt with bladder and other low estrogen issues may have innovative solutions, as well as ideas about which doctors to use.
  • Approaching things holistically: For some, lifestyle changes can make a significant difference to their bladder symptoms. Try experimenting with different strategies, such as pelvic floor exercises, in combination with medical treatment.
  • Persistence: Some of the treatments for GSM and other bladder changes take time to work. For example, it can take time for medication or physical therapy to start making a noticeable improvement.

Bladder dysfunction is a common challenge, especially later in life and during times of major hormonal change. Low estrogen bladder symptoms can include incontinence, overactive bladder, and pain.

However, these symptoms are treatable. A holistic approach that uses medication, lifestyle changes, physical therapy, or other interventions may help reduce them or help someone manage them.

A person should speak with a doctor if they have any concerns they may have low estrogen or if they are experiencing bladder symptoms.