Can Hormone Therapy Help Stop the Urgent Feeling to Pee?Â
Lauryn Higgins
That sudden, urgent need to pee, often with little warning, is a frustrating and surprisingly common experience for many women in midlife. While it’s easy to dismiss as just another symptom of aging, urinary urgency can seriously affect daily life, from disrupting sleep to creating anxiety in social settings.
Now, new research is shedding light on how this issue may be linked to hormonal shifts during the menopause transition—and whether the treatments many women turn to for relief could be helping or possibly complicating the picture.
As scientists dig deeper into the connection between bladder health, menopause and hormone therapy, important questions are emerging. Could hormones be influencing more than just hot flashes and mood swings? And what does this mean for women navigating these changes?
Here’s what the latest findings suggest and why they matter.
What the Research Reveals About Bladder Health and Menopause
New research, published in the journal Menopause, examined more than 3,100 women from the CARDIA (Coronary Artery Risk Development in Young Adults) cohort to explore how bladder symptoms change during the menopause transition, and whether hormone therapy makes a difference.
Researchers grouped participants by menopausal stage (premenopausal, perimenopausal and postmenopausal) and looked at how each group reported urinary urgency, incontinence and other bladder-related concerns.
They found that women in perimenopause were more than twice as likely to report urinary incontinence compared to premenopausal women. Those who were postmenopausal also had significantly worse bladder function scores, suggesting that bladder symptoms tend to intensify as women move through midlife.
Even more surprising was the data on hormone therapy.
Among postmenopausal women, those who were using hormone therapy actually had slightly worse bladder health scores than those who weren’t. Their scores were, on average, about six points lower, and they also reported more lower urinary tract symptoms overall.
Why Menopause Can Increase Urinary Urgency
Why does the urge to pee seem to hit harder in your 40s and 50s? Experts say changes in hormone levels during perimenopause and postmenopause may be part of the answer.
“I see a lot of women who have incontinence and leak more before their period,” Dr. Sarah Boyles, medical advisor to Uresta, a company offering a discreet, reusable internal device to help women manage urinary incontinence, tells Flow Space. “This is because of the decrease in estrogen, and maybe progesterone too, that happens before menstruation. A decrease in estrogen in the pelvic tissues will also worsen all leakage.”
And incontinence is more common as we age, Boyles says. It is more common in women who have given birth, seen an increase in weight, had a hysterectomy, have constipation or have previously been a smoker.
“The system that keeps us dry is a delicate one,” she says. “All of the above things can impact leakage and damage to pelvic floor muscles can lead to incontinence over time. Additionally, our muscles atrophy as we age (starting as young as 30), so actively strengthening these small pelvic muscles is important prevention.”
Why Hormone Therapy Might Not Always Help With That Gotta-Go Feeling
Hormone therapy (HT) is often recommended to ease a range of menopausal symptoms—think hot flashes, night sweats, mood swings. But when it comes to bladder symptoms like urgency or leakage, the benefits of HT may not be so clear-cut.
According to the latest study, postmenopausal women who were using hormone therapy actually reported slightly worse bladder health than those who weren’t. Their overall bladder symptom scores were lower, and they reported lower urinary tract symptoms, including that sudden, gotta-go feeling known as urgency urinary incontinence.
Researchers and experts noted that they weren’t entirely sure why this is.
“Vaginal estrogen helps with incontinence but systemic, patch or oral does not,” says Boyles. “Oral estrogen has been shown to increase the risk of leaking as has estrogen and some types of progesterone. We don’t really know why this is, it may be that the hormones impact collagen metabolism in some way. So if you have vaginal and bladder symptoms only, you should be on vaginal estrogen. If you have systemic symptoms too, you may need systemic estrogen and vaginal estrogen.”
However, researchers suggested that estrogen therapy might not provide the same kind of support for bladder tissue that it does for other menopausal symptoms—or that it could even exacerbate certain issues in some women.
“It’s also possible that the type, dose or delivery method of hormone therapy matters more than previously understood when it comes to urinary symptoms,” says Dr. Alex Mafdali, a primary care physician with Baptist Health Orthopedic Care.
In other words, hormone therapy isn’t a guaranteed fix for midlife bladder changes—and for some women, it may not help at all.
“Estrogen loss also affects pelvic floor muscles, which support the bladder and help maintain continence. When these muscles weaken, it becomes harder to control the flow of urine, especially during everyday actions like coughing, sneezing or exercising—this is known as stress urinary incontinence, which often overlaps with urgency symptoms,” says Mafdali.
In addition to physical changes, some researchers suggest that hormonal shifts may affect how the bladder communicates with the brain, potentially lowering the threshold for urgency. Add in common midlife stressors, sleep disruptions and other menopausal symptoms, and it’s no wonder bladder issues often emerge or worsen during this stage.
The good news?
“Understanding what’s behind these changes is the first step toward managing them—and finding strategies that work for your body,” says Mafdali.
