If you clicked the link to this post there is a good chance you are one of the 50% of women with urinary leakage that began or worsened around the time of menopause. Maybe you’ve mentioned it in passing to a friend when you rushed to find a bathroom at the department store or when you squeezed your legs together after a joke at a party. Maybe it’s the reason you’ve skipped out on the revitalization of the trampoline fitness movement.

Leakage of urine, also known as incontinence, affects women of all ages however, it becomes much more common after menopause. Why is this you ask? To understand we have to take a step back in time to understand our bodies and where we came from. When vulva owners are babies they have no hormones in their tiny bodies. Because of this, the vulva is small, there are no labia minora and the vaginal opening is super duper narrow. As a result, baby vulva owners get diaper rash, raw/irritated tissue, and constant leaking into diapers.

Fast forward to puberty and BOOM!! hormones surge, our bodies change. The vulva grows a new neighbor, the labia minora, and the vaginal opening becomes pink, stretchy, and starts to lubricate. We go about our lives for 40+ years with a vagina that looks like our middle school sex-ed diagrams. Little do we know, change is on the horizon.

Around the age of 52, often before and sometimes after, the ovaries decide they’ve worked hard enough and put in their retirement notice in the form of hot flashes, insomnia, night sweats, and mood swings to name a few. These symptoms occur because in retiring, the ovaries have stopped making estrogen, progesterone, and testosterone. The genital tissue has thousands of hormone receptors which have been sucking up these hormones since you hit puberty. Now the ovaries have cut them off cold-turkey and it starts to show. The tissue goes back to being raw, thin, and irritated like the baby vulva. The opening of the vagina narrows or shortens and the tissue dries out. The lining of the urethra (the tube we pee out of) thins and the tissue support around it weakens causing urine leakage.  The vagina loses its acidity, making you more susceptible to urinary tract infections. Not only this, your labia minora start to disappear. YES! Because your vulva and vagina are not getting these hormones anymore, a part of your genitals DISAPPEARS!

What other changes do we notice? Urinary frequency, urgency, incontinence, pain with urination as well as pelvic pain, and constipation to name a few.

These changes together make up a condition called genitourinary syndrome of menopause, also known as GSM. The lack of hormones caused by menopause leads to significant genital and urinary symptoms. Since your ovaries have checked out for good, the symptoms won’t get any better – they will continue to get worse.

For our readers who have just checked off the boxes on the majority of these symptoms, we’re elated to inform you – this is TREATABLE.

If you’re reading this and just saw your future flash before your eyes because you have genitals that are still happily bathing in hormones – don’t worry, not only is this treatable, it’s PREVENTABLE!

What is the magic potion you ask? Well, it’s really not magic at all. We simply give the tissue back what it wants – hormones. When estrogen or DHEA (a precursor to estrogen and testosterone) is applied directly to the vulva and vagina, the hormone receptors rejoice and begin to stimulate rejuvenation of the tissues in the form of thickening, increasing lubrication, tissue strength and this translates to improvement in or complete resolution of urinary incontinence, decreased irritation, improvement in pain with sex and decreased urinary infections to name a few.

Vaginal hormones are safe and easy to use and come in a few options: vaginal inserts, rings, and creams. Women typically see results within 4-6 weeks of consistent use. Importantly, the hormones are acting locally on the vaginal tissue; there is hardly any absorption into your bloodstream which means your overall hormone levels don’t change and as a result, there is no increased risk of cancer. Speak to your primary care doctor, gynecologist, or urologist about this absolutely essential medication.

About The Authors:

Meredith C. Wasserman MD MS
Chief Resident, Division of Urology
Brown University/Lifespan
Providence, RI

Meredith Wasserman is a medical doctor and chief resident in the division of urology at the Warren Alpert School of Medicine at Brown University in Providence, Rhode Island. She earned a bachelor’s degree in human physiology at Boston University followed by a Master’s degree in physiology at Georgetown University. She earned her medical degree from the Warren Alpert School of Medicine at Brown University. Upon completion of residency in July 2022, she will begin fellowship training in female pelvic medicine and reconstructive surgery at New York University.

Rachel S. Rubin MD
Urologist and Sexual Medicine Specialist
Assistant clinical professor in Urology at Georgetown University Hospital

Rachel Rubin is a board-certified urologist and sexual medicine specialist. She is an assistant clinical professor of Urology at Georgetown University and works in a private practice in the Washington DC region. She is one of only a handful of physicians fellowship-trained in male and female sexual medicine. Dr. Rubin is a clinician, researcher, and vocal educator in the field of sexual medicine. She completed her medical and undergraduate training at Tufts University, her urology training at Georgetown University, and her fellowship training under Dr. Irwin Goldstein in San Diego. In addition to being education chair for the International Society for the Study of Women’s Sexual Health (ISSWSH), she also serves as an Associate Editor for the Journal of Sexual Medicine Reviews.