DO YOU HAVE IC OR IS IT THE MENOPAUSE?
THE RELATIONSHIP BETWEEN OESTROGEN AND PAINFUL BLADDER SYMPTOMS
No one told you menopause would be like this. Painful peeing, being too embarrassed to talk about it and feeling sort of ashamed that you seem to have a constant UTI (even though the standard tests may well be coming back negative).
It’s been suggested you “just have an overactive bladder” and implied that it’s because you’re old, get used to living with it and buy some Tena pants. You're unable to enjoy sex, sit comfortably, or wear tight fitting trousers. Maybe you should stock up on KY Jelly - even though it burns the hell out of you because your vaginal skin is so sore and chapped.
Have you been labelled with interstitial cystitis (IC) or genitourinary syndrome of menopause (GSM)? The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including, not only genital symptoms (dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function), but also urinary symptoms (urgency, dysuria). It was probably implied that it’s just something you have to put up with now that you’re getting older. Because, of course, as soon as you hit menopause everything naturally dries up, shrivels up and there’s nothing you can do, it's just ageing, right?
Wrong.
Urinary issues are not just a natural part of ageing and menopause.
You don’t just need to train your brain to ignore the urgency signals from your bladder.
You don’t just need to drink less tea and coffee and alcohol.
You’ve probably already tried lubricants, vaginal washes, Canesten and antifungal medications, the IC diet/low acid diet/Candida diet, reducing tea, coffee, alcohol. And although you’ve been told you have an overactive bladder and IC, you feel deeply that there’s more going on for you.
You may well be right. The missing part of your story so far may well be menopause. Dive into this blog post to find out what menopause and bladder pain have in common, the role oestrogen plays, and what you can do to help heal your bladder.
WHAT YOU NEED TO KNOW ABOUT OESTROGEN AND THE MENOPAUSE
Many of the symptoms we might put down to growing older - fatigue, joint pain, anxiety, insomnia, weight gain, low libido, vaginal dryness, poor bone health - can actually be attributed to hormonal decline. All sex hormones (oestrogen, progesterone, testosterone) are generally at a much lower level. You’re going to be especially interested in oestrogen at this point, because this hormone
Maintains bone density.
Protects the brain.
Protects the heart.
Keeps skin supple.
Helps you concentrate and takes care of brain health.
Is involved in vaginal lubrication.
Symptoms associated with low oestrogen and/or change of vaginal pH:
Vaginal dryness
Burning or painful sex
Painful urination
Recurrent UTIs
Bladder urgency
Stress incontinence
Vaginal wall prolapse
Thrush
Bacterial vaginosis
All sounding a bit familiar? That’s why your IC diagnosis is probably not quite accurate; your GP may well not be taking into account your peri/menopausal journey. The other issue with IC diagnosis is that, due to limitations in urinary testing, most women are told they don’t have a UTI and IC is a bit of a blanket term. And if they’re around the menopausal phase in their life, they’ll probably be told that it’s an overactive bladder because they’re older and, “that’s just what happens”.
If you’re curious about the different medical terms assigned to bladder pain, you should take a look at this blog post on the difference between interstitial cystitis and chronic UTI.
WHY YOU MIGHT BE EXPERIENCING INCREASED BLADDER PAIN THROUGH THE MENOPAUSE
Lots of women get fobbed off with IC when menopause and perimenopause can actually be a trigger for recurring UTIs and vaginal health issues. With menopause you lose oestrogen. But you need oestrogen. When oestrogen drops, you’re at an increased risk of a UTI because this alters the vaginal pH; lactobacillus (the protective bacteria in your vagina) die off and you become more susceptible to infections. The presence of oestrogen feeds and promotes lactobacilli growth. So as you lose oestrogen from menopause, you lose these protective species, making you more prone to infections such as bacterial vaginosis, thrush and UTIs.
Plus bladder and/or vaginal microbes can be out of balance, which is when urinary symptoms can set in. When your protective friendly bacteria drop, you’re more likely to experience vaginal symptoms such as dryness, soreness, chapped skin, infections. And UTIs become more likely because bacteria can translocate to the bladder and trigger a UTI. Your vaginal health will likely have been ignored completely by your doctor, and an imbalance in the vagina can be driving your urinary symptoms and UTI risk.
Menopausal women may experience a weakening of the pelvic floor muscles, which can lead to incomplete bladder emptying. When the bladder doesn't empty fully, it can leave behind residual urine that provides a breeding ground for bacteria. This stagnant urine can lead to bacterial growth and increase the risk of UTIs. Optimising diet and using targeted supplements such as probiotics and natural antimicrobials is helpful, as well as supportive to your immune system.
HOW TO SUPPORT YOUR BLADDER HEALTH THROUGH THE MENOPAUSE
One option is to speak to your doctor about oestrogen pessaries which act locally in the vagina to support the integrity of the vaginal skin. This, in turn, balances the vaginal pH so the lactobacillus can stabilise. This would be a long-term treatment and can be hugely helpful.
It’s essential to build on this nutritionally, by supporting vaginal and urinary health with targeted probiotic strains, eating pre/probiotic foods and eating foods to support the immune system, as well as fat-soluble vitamins to support the mucosal lining of the vagina.
How can probiotics help the bladder and vagina in menopause? Lactobacillus strains of probiotics help with:
Lactic acid production, which maintains a balanced ph that prevents infections
Immune regulation and pathogen inhibition because they make antibacterial byproducts to keep infections out
Instead of a breeding ground for bad bacteria, the right probiotic strains help make your bladder inhospitable to the bad guys. This is about creating an (healthy for you) environment that’s impossible for the baddies to survive, let alone thrive, in.
Supporting optimal vaginal health and vaginal pH can have a positive impact on urinary symptoms. Looking after your immune system by optimising vitamin D, eating fat-soluble vitamins and zinc, among other things also protects against UTIs. It’s important to support both the vaginal and bladder environments. So many standard treatments focus on “killing” and nuking all the bacteria but ignore the overall bladder/vaginal environment. For example we can work on the health of the vaginal lining (mucosal membranes), eat fat soluble vitamins that are involved in mucosal membranes, targeted probiotic strains to rebalance and maintain balance in the vagina and bladder.
With tailored supplements and dietary support - plus the option of vaginal microbiome testing - you can get the answers you’ve been searching for, as well as the relief from bladder discomfort. You can regain your zest for life and actually enjoy this next chapter.
Sound interesting? Book a call with me and let’s chat about your menopause journey.
