What you’ll learn:
- People can experience urinary incontinence during menopause due to hormonal changes, but aging is a bigger factor.
- Lifestyle changes, like diet adjustments, regular exercise, and stress management, can significantly improve symptoms of urinary incontinence during menopause.
- A variety of treatment options are available to help manage urinary incontinence effectively.
Whether it’s leaking with a sneeze or feeling a sudden, urgent need to go, urinary incontinence can catch you off guard and definitely affect your daily life. Incontinence can happen at any age, and while you may notice it during menopause as hormone levels shift and pelvic floor support weakens, menopause itself isn’t considered a direct cause.
Urinary incontinence is, at its most basic, the involuntary leaking of urine, but there are a variety of different types and causes. Two of the most common types are stress incontinence and urge incontinence. Here’s a look at the differences:
- Stress incontinence is a sudden loss of muscle control caused by physical exertion, like coughing, sneezing, or exercising.
- Urge incontinence is a strong, unexpected urge to pee followed by involuntary leakage.
Some experience both. Early signs may include more frequent bathroom visits, occasional leaks, or increased urgency. How common is it? One study of several hundred postmenopausal people found that nearly 40% experienced urinary incontinence. Stress incontinence was the most common at about 21%, followed by urge incontinence at about 11%.
Of course, as you age, other things can cause urinary incontinence. Let’s talk about what else might be happening and then find some effective ways to manage it.
Urinary incontinence during menopause: When is it most likely?
Menopause is often divided into three stages: perimenopause, menopause, and postmenopause. Urinary incontinence tends to become most noticeable postmenopause, when estrogen levels have settled into a long-term lower range. This drop in estrogen can lead to thinner, less elastic tissues in the pelvic area, potentially weakening bladder support, but hormones aren’t the only factor.
Here’s what’s happening: As estrogen levels decline during and after menopause, changes in the vaginal and urinary tract can lead to a group of symptoms known as genitourinary syndrome of menopause, or GSM for short. One common issue that falls under this umbrella is incontinence. GSM also includes symptoms like vaginal dryness, burning, irritation, painful intercourse (dyspareunia), and increased urinary urgency or frequency. These symptoms are all connected to the thinning and drying of tissues in the vagina and urethra due to lower estrogen levels, but also concurrent age-related changes.
The average age of menopause, officially marked by 12 consecutive months without a menstrual period, in the U.S. is 51. Around this time is when many women also start experiencing pelvic floor weakening, reduced muscle tone, and increased risk of incontinence due to cumulative stress on the body caused by aging, not just hormones.
Large studies show that urinary incontinence becomes more common with age, rising from about 28% of females in their 30s to over 55% in their 80s and 90s. While some first notice mild bladder leaks in their 40s, especially during perimenopause when hormones are fluctuating, the prevalence of incontinence increases significantly during postmenopause and tends to persist or worsen with advancing age.
Different types of incontinence also follow age-specific patterns:
- Stress incontinence is often most common in women between 35 and 50.
- Urge incontinence becomes more prevalent later in life, typically after age 60. Many women experience a mix of both types as they enter their 60s and beyond.
The causes of urinary incontinence during and after menopause
Urinary incontinence is usually caused by a combination of hormonal, physical, and lifestyle factors. Here’s a look at what’s happening:
- Hormonal shifts: Estrogen helps maintain the strength and elasticity of tissues in the bladder, urethra, and pelvic floor, so when levels decline, these areas may weaken, become thinner, or more easily irritated. That can lead to increased bladder sensitivity, urgency, and leakage, especially during postmenopause, when estrogen has stabilized at its lowest levels.
- Age-related muscle changes: As we age, muscles—including those in the pelvic floor—naturally lose strength and elasticity, which can make bladder control more difficult. These muscles help support the bladder and regulate urine flow, so when they weaken, leaks during movement (stress incontinence) or frequent urges (urge incontinence) can become more common. The National Institute on Aging notes that age-related muscle loss is one of the leading causes of incontinence in older adults, and it can be worsened by other factors like medication side effects, chronic conditions, or limited mobility.
- Physical strain on the pelvic floor: Activities or conditions that increase abdominal pressure, like chronic coughing, heavy lifting, prolonged sitting, or excess abdominal weight, can put repeated stress on the pelvic floor muscles. Over time, this pressure may weaken the support structures around the bladder and urethra, leading to stress incontinence, where urine leaks during physical movement or exertion. According to clinical research, this type of strain is a well-established risk factor for developing pelvic floor dysfunction and urinary leakage, especially in people who’ve experienced childbirth or age-related tissue changes.
- Lifestyle habits: Certain daily habits can quietly contribute to bladder issues over time.
- Smoking, for example, not only irritates the bladder lining but also causes chronic coughing, which puts repeated strain on the pelvic floor and increases the risk of stress incontinence.
- Other habits, like not drinking enough water or eating a low-fiber diet, can lead to constipation. Straining during bowel movements increases abdominal pressure and can worsen urinary symptoms by placing additional stress on pelvic organs (NCBI).
- Underlying medical conditions: Chronic health issues like diabetes, stroke, multiple sclerosis, or Parkinson’s disease can interfere with the nerves that control bladder function.
- Family history: Some research suggests that genetics may play a role in urinary incontinence, possibly by influencing pelvic anatomy, tissue integrity, or how the bladder and urethra function over time. Studies have found that women with a family history of incontinence, particularly mothers or sisters with the condition, may have a higher risk themselves. This connection isn’t as well understood or as strongly predictive as other risk factors like aging, childbirth, or hormonal changes. So, while genetics may increase your baseline risk, lifestyle and health habits still play a major role in symptom development and management.
Does urinary incontinence worsen after menopause?
For many women, yes—urinary incontinence tends to stick around or gradually worsen after menopause rather than going away on its own. While the hormonal ups and downs of perimenopause may settle postmenopause, aging continues to impact pelvic muscles, nerves, and bladder control. In fact, research shows that both the frequency and severity of leakage often increase in later postmenopausal years.
But everyone’s experience is different. Some people with mild symptoms around menopause may not get significantly worse, especially if they take steps like strengthening their pelvic floor, maintaining a healthy weight, or seeking treatment early. Interestingly, new-onset incontinence is less common right after menopause than during the transition, suggesting things may temporarily stabilize for some.
Still, without some kind of intervention—whether that’s lifestyle changes, pelvic floor therapy, or medical support—incontinence typically doesn’t improve on its own. That’s why it’s important to take action in midlife and beyond. With the right support, you can improve symptoms and protect your long-term bladder health.
Diagnosing urinary incontinence: When to seek professional help
Diagnosing urinary incontinence typically starts with a conversation about your symptoms, health history, and lifestyle. From there, your doctor may use a few standard tools to get a clearer picture:
- Pelvic exam: Checks for muscle weakness or pelvic organ prolapse
- Bladder diary: Tracks your bathroom habits, fluid intake, and any leaks
- Urinalysis: Screens for infections or underlying conditions like UTIs or diabetes
- Stress test: Assesses leakage during actions like coughing
- Advanced tests: Imaging or urodynamic studies may be used in more complex cases
You don’t have to wait until symptoms feel unmanageable. Reach out to your healthcare provider if:
- Leaks are frequent or disrupt your life
- You feel burning or discomfort when urinating
- You wake up multiple times at night to go to the bathroom
- You experience vaginal dryness, frequent UTIs, or other signs of genitourinary syndrome of menopause (GSM)
- Bladder issues are causing anxiety or limiting activities
When you’re ready to seek help, bring symptom notes with you. Tracking when leaks happen, what you were doing, how much urine was released, and how much you drank can help your provider tailor treatment to your needs.
How to prevent or reduce your risk of urinary incontinence during menopause
While incontinence can be a part of aging, there are ways to prevent and reduce symptoms. What you eat, how you move, and how you maintain your overall health can all help.
Lifestyle adjustments that can reduce incontinence during menopause
Changes in your daily habits can make a big difference in managing urinary incontinence during menopause.
- Let’s start with your diet. A study found that those who followed a calorie-reduced eating plan saw significant improvements in incontinence, especially if they lost weight. Focus on lean proteins, healthy fats, and fiber-rich foods like beans, berries, and leafy greens. Fiber also helps prevent constipation, which can put extra pressure on your bladder.
- Watch what you drink. Caffeine, alcohol, and carbonated drinks can increase urgency and frequency. Try swapping them out for water or herbal tea and see if your symptoms improve. And while it may seem counterintuitive, staying hydrated throughout the day as opposed to drinking a lot of water all at once can actually reduce irritation from concentrated urine.
- Losing weight can help: A study showed that losing 5 to 10% of body weight led to nearly a 50% drop in weekly leaks among people with BMIs between 25 and 50.
- Stay active. Low-impact movement like walking or yoga supports bladder health, stress relief, and better sleep, all of which are linked to fewer symptoms.
- Quitting smoking may help. Smoking can irritate the bladder and lead to coughing that strains your pelvic floor.
Medical treatments and professional advice for incontinence
If lifestyle changes aren’t enough, there are several effective medical treatments to consider, including medications, some forms of HRT, pelvic floor therapy, devices, and even surgery. Let’s take a look at the options:
When hormone replacement therapy (HRT) can help
Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT or MT), can help with some urinary symptoms, but it depends on the type.
- Vaginal estrogen is the most effective form for bladder-related issues. It can ease urgency, frequency, and discomfort by helping restore the tissues in the urinary tract and vaginal area. This form of estrogen is applied directly through creams, rings, or tablets and is supported by experts for treating these kinds of symptoms.
- Systemic estrogen, which comes in pills or patches, has mixed results. For some people, it may help. For others, it could actually make incontinence worse. That’s why it’s usually not prescribed for urinary symptoms alone.
- Estrogen combined with progestin is typically used to protect the uterus in females who still have one, but it may reduce some of the benefits of estrogen when it comes to urinary health.
If you’re thinking about hormone therapy, it’s important to talk with your doctor and weigh the risks and benefits based on your full health picture. For more on what HRT can and can’t do, check out these common misconceptions about HRT.
Non-hormonal medications and advanced therapies for incontinence
If you’re looking for treatments beyond HRT for addressing bladder control issues, you have several effective options. Let’s explore some treatments:
Pelvic floor therapy
Working with a pelvic floor specialist can help you learn how to properly engage the muscles that support your bladder. Similarly, kegel exercises—squeezing and relaxing the pelvic muscles—can be done at home and are one of the most effective ways to reduce leaks over time.
Other medications
- Anticholinergic medications: These drugs help relax the bladder, making it less likely to spasm or trigger sudden urges. They can be especially helpful for urge incontinence. Some common options include oxybutynin (Ditropan) and tolterodine (Detrol). This could mean fewer disruptions to your sleep.
- Beta-3 adrenergic medications: Medications like mirabegron (Myrbetriq) are newer options that also relax the bladder muscle without some of the side effects linked to anticholinergics. They may be a better fit if you’re sensitive to traditional medications, but they can raise blood pressure in some people.
- Electrical stimulation: This technique uses low-level electrical currents to strengthen pelvic muscles and calm an overactive bladder. It might sound unconventional, but many find it surprisingly effective.
- Botulinum toxin injections: You might be familiar with Botox for cosmetic use, but it can also help your bladder! Botox injections can provide relief from an overactive bladder for several months.
Devices and surgical treatments
- Pessary devices: A pessary is a small, removable non-surgical device that’s inserted into the vagina to help support the bladder or uterus. It works by lifting and stabilizing pelvic organs, which can reduce pressure on the bladder and help prevent leaks.
- Surgical options: Surgeries for urinary incontinence in menopausal women typically focus on providing better support to the bladder or urethra. Common procedures include sling surgeries, which use a strip of mesh or tissue to support the urethra, and bladder neck suspension, which lifts and secures the bladder to prevent leaks—usually recommended when other treatments haven’t worked.
Emerging therapies
Exciting new treatments like stem cell therapy and gene therapy for bladder control are on the horizon. While still in development, they offer hope for even more options in the future.
Non-hormonal medications and advanced therapies for incontinence
Herbal remedies are a popular option for managing incontinence during menopause, but the research behind these options is limited and often inconclusive. Here’s a look at some of the most talked-about natural remedies and what current research says:
While some of these remedies may offer general support, none are proven to treat incontinence on their own. Most findings are early-stage, and supplements aren’t regulated like medications. For safety and effectiveness, it’s best to talk to your healthcare provider before trying any new supplement.
Finding relief from urinary incontinence during menopause
Urinary incontinence during menopause is common, but that doesn’t mean you have to live with it. These symptoms can affect your daily life, but consistent changes, like adjusting your diet, staying active, and strengthening your pelvic floor, can make a meaningful difference. Understanding the connection between hormonal shifts and bladder changes helps you take steps that truly support your body.
If symptoms persist, there are effective treatments available. From vaginal estrogen to non-hormonal medications, pelvic floor therapy, or in-office procedures like Botox injections or electrical stimulation, you have choices. Managing incontinence may take time, but with the right support and care, many people find real relief. Menopause may bring challenges, but it can also be a time to prioritize your well-being and feel more in control.
