HRT and bladder problems

[HRTORNOT1]

I am in full blown perimenopause it seems as periods all over the place for last two years. In the last 6 months or so I have been having some bladder issues (a handful of instances where I’ve leaked before getting to the toilet and once I had leakage when I was just sitting at my desk). I went to the GP this week and they prescribed topical oestrogen and I am doing pelvic floor exercises three times a day.

I am getting intense anxiety especially on waking up in the mornings, plus brain fog. I would really like to go on oral HRT to see if it helps the anxiety and brain fog as the anxiety especially is becoming unbearable but I’ve googled it and discovered that oral HRT or patches can actually make bladder problems worse!

I’m not sure what to do. Anyone have any experience of this?

It's one of those things where you need to try it and see.

It might be worth paying to see a women's physio (one who specialises in your type of issues) and having an assessment of your pelvic floor to see what's going on. You could have urge incontinence, (which won't be helped by pelvic floor exercises) or stress incontinence (weak pelvic floor) or a mix of both.

Vaginal estrogen should help but it's not a quick fix- it can take 3 or 6 months.

Although there is documentation about HRT making bladder issues worse, it's probably rare and may well depend on the type of progesterone.
Most HRT prescribed now is an estrogen patch or estrogen gel + micronised progesterone. In peri you'd use progesterone on a cycle (12 days a month) so you'd soon see if it was making things worse.

You probably need to deal with each thing separately- work on your pelvic floor and consider systemic HRT for your anxiety.

HRT has really helped me with this. I have the oestrogen gel and progesterone capsules and then also pessaries for the localised issues. I was having a very bad time with leaking as well as a very severe UTI that took an age to get over. Much better now though I think my trampolining days had better stay in the past.

Thanks for your response. My understanding is pelvic floor exercises will help urge incontinence? Will they not then?I think that’s what I have as most times when it’s happened it’s been when I’ve been walking to the toilet.

Thank you. So for you the gel capsules didn’t make the leaking worse?

I’m only 46 and never had children. The GP said I’m very young for the leaking to have started given no children, so she has also referred me for blood tests and a scan to check nothing else is going wrong. I thought leaks didn’t happen until women are older 😕

It's perhaps worth you looking online at info about urge incontinence.
And overactive bladder.

Sometimes pelvic floor exercises can make it worse as they make the PF muscles too tight .

And if you've not had children (vaginal birth etc) it's unlikely your PF is slack. But loss of estrogen does cause the lining to thin , become more irritated and can mean you need to rush to the loo.

Vaginal estrogen can help with this but it does take time. It won't do any harm so it's worth carrying on with it.

There are also drugs for overactive bladder which can calm it down.

You really need to be examined by a specialist or a women's physio. They can use devices that test your muscles and can give a more precise diagnosis.

Thanks. I’m getting very confused by all the information online. e.g. I don’t understand the difference between an overactive bladder and urge incontinence. My brain fog isn’t helping. I’m making sure I relax my pelvic floor but I suppose it could be tight opposed to weak. An appointment with a pelvic floor physio sounds like my next step.