Bladder control problems have been strongly linked to low estrogen levels in many women. During and after menopause, a woman’s body decreases the amount of estrogen produced in earlier years. When this happens, the female genitourinary tract undergoes significant changes. As a result, the vagina and surrounding tissues may contract and lose flexibility.

Connective tissue that helps to maintain strength of the vaginal wall may weaken. Numerous problems can develop including urethral stenosis (narrowing of the urethra) and prolapse of the structures near the vagina including the bladder, rectum and intestine. The result can be protrusion of these structures into the vaginal canal. This can give a woman an uncomfortable feeling of fullness in the vagina. It can cause pain during sexual activity. In cases of severe pelvic organ prolapse, the bladder or rectum can actually protrude outside of the vaginal opening.

The urethra, which lies against the anterior vaginal wall, may not be as pliable and may contract. This can prevent the bladder from emptying completely. The result can be an increase in urinary frequency, urgent or frequent needs to urinate, recurrent bladder infections, bladder inflammation and urinary incontinence.

Many of these conditions and symptoms can be helped with estrogen replacement therapy. This can be accomplished with oral estrogen products or estrogen cream or rings in the vagina.

IS ESTROGEN REPLACEMENT THERAPY SAFE?

The answer is not a simple yes or no. Over the years, there have been many medical studies done to try to answer this question. We know that there is medical evidence that estrogens can increase the risk of developing uterine cancer and some types of breast cancer. There is data that suggests that ovarian cancer may also increase when women take estrogen preparation. Adding progesterone to estrogen can lower that risk significantly.

There have also been studies that suggest a possible link between estrogen therapy and the development of heart disease and strokes. Medical evidence is unclear, though, so we don’t know that this occurs for certain at this time.
Adding progesterone to estrogen replacement therapy can decrease the risk of cancer development significantly.

The use of low dose estrogen creams applied directly to the vaginal tissues does not appear to carry the same risk of cancer development as oral estrogen preparations. For this reason, we use these creams exclusively in select patients at Pacific Coast Urology’s Women’s Bladder Control Center of Excellence.

ARE BIO-IDENTICAL HORMONES SAFER?

In a word, NO. While many have promoted bio-identical hormones as being safer than traditional preparations, there are no medical studies that support this claim. A woman’s body cannot differentiate between estrogen preparations, whether they are bio-identical or not.

WHAT SHOULD A WOMAN DO?

In all cases, it’s important to discuss the potential benefits and risks of all medical therapies. At our Woman’s Bladder Control Center of Excellence we will have that discussion with you if we feel that low dose estrogen cream may help your bladder control problem. We also can work closely with your gynecologist or other primary care provider to coordinate your care to ensure that you get the safest, best results possible.
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