Signs of menopause: Common symptoms and the link to incontinence

Navigating the choppy waters of a new life stage isn’t easy. You might feel as though you’re losing control of parts of your body. You may be wondering are your bladder symptoms due to menopause? Or is there something else entirely going on? You're not the only one to worry about this. 

So, we’ve put together a guide on the main menopause symptoms to be aware of – as well as how the menopause might lead to urine leaks (or other side effects). Read on for information about the causes, symptoms and link between menopause and incontinence. 

The menopause is when a woman stops getting her monthly period, marking the end of her reproductive years. During the menopause, the ovaries stop producing oestrogen and releasing eggs. This means that a woman can no longer get pregnant. She may experience other symptoms too, which we’ll cover below, as we go through the signs of menopause in more detail. 

It’s a normal part of getting older, with the average age of menopause in the UK being 51. In fact, 1 in 100 women will experience menopause between the ages of 40-50. And 1 in 1000 will be under age 40. However, some women who have had surgery to remove their ovaries, or have had certain cancer therapies, or other medial treatments, may experience a sudden medically (or surgically) induced menopause. Read Aoife’s story to learn more about this. 

Perimenopause signs

Translating to “around menopause”, the perimenopause usually begins eight to ten years before the menopause. It marks the time your body starts to transition into the menopause (and signs of early menopause might begin here). It typically happens in a woman’s 40s, although some may notice changes in their 30s. 

For example, the menstrual cycles can shorten or lengthen, periods can become lighter or heavier with clots and flooding, and there may be cycles in which the ovaries don’t release an egg. Periods can also stop for months and then restart. 

Post-menopause signs

Post-menopause refers to the rest of a woman’s life, after she has gone 12 consecutive months without having a period. For many women, menopause symptoms may ease during this stage, although some post-menopausal women continue to experience symptoms a decade or so after their cycles end.  

Some studies have shown up to 45% of post-menopausal women are still having symptoms after age 65. However, although most menopausal symptoms improve with age, genitourinary syndrome of menopause symptoms will worsen with age. ‘Genitourinary syndrome of menopause’ (GSM) refers to multiple menopausal symptoms: not only genital symptoms (e.g. dryness and irritation), sexual symptoms (e.g. dryness, discomfort or pain) but urinary symptoms, as well. For example, urge incontinence.  

Due to decreased oestrogen levels, post-menopausal women have an increased risk of developing a number of health conditions, including osteoporosis, heart disease, and incontinence. Medication and healthy lifestyle choices, including diet and exercise, may reduce these risks, but it’s important to talk to your doctor to learn what’s best for you. 

Menopause can be caused by: 

1. A natural decline in reproductive hormones. Oestrogen and progesterone levels drop as a woman ages, leading to a decline in fertility. 
2. Surgery that removes the ovaries. The ovaries produce oestrogen, testosterone and progesterone, which means removing them may induce sudden menopause. 
3. Chemotherapy and radiation therapy. Certain cancer therapies can induce menopause; however, it’s not always permanent following chemotherapy, depending on your age at treatment and will only happen as a result of radiation therapy if directed at the ovaries. Other cancer treatments can also keep you in a menopausal state. 
4. Primary ovarian insufficiency. Primary ovarian insufficiency happens when the ovaries stop functioning,  before age 40. The ovaries stop producing regular amounts of the hormone oestrogen or releasing eggs, often leading to infertility. This condition is sometimes confused with early menopause; however, these aren’t the same. POI occurs before the age of 40 and early menopause is between 40-45 years of age. 
5. Medication to suppress the ovarian function to treat conditions such as fibroids or PMDD (Premenstrual Dysphoric Disorder). 

We have put together a detailed list of common menopause symptoms, so that you can consider if you are officially entering this stage of your life: 

• Bladder weakness, or increased urination, urgency to pee and inability to make it to the loo on time. Waking up to pee at night. Leaking when you cough, sneeze or exercise 
• Hot flushes  
• Night sweats  
• Insomnia, or difficulty sleeping 
• Mood changes, including low mood, anxiety and depression 
• Reduced sex drive 
• Problems with memory and concentration/brain fog 
• Headaches and worsening migraines 
• Stiff joints, aches and pains 
• Palpitations, or “racing heart” 
• Sore or tender breasts, itchy nipples 
• Vaginal dryness and pain 
• Weight gain
• Reduced muscle mass 
• Thinning hair and dry itchy skin 
• Urinary tract infections (UTIs) 

Menopause symptoms can vary from person to person, and their severity can also change. In a honest chat around body confidence with Lisa Snowdon, case study Lynda, age 59, revealed:  

This is what experts' term ‘Genitourinary Syndrome of Menopause’ (GSM): genital, sexual and urinary symptoms. 

1. Loss of tissue condition 

The drop in oestrogen that happens during menopause can cause the lining of the urethra (the tube that passes urine from the bladder) to thin. The vaginal and bladder tissue also becomes less elastic, and the pelvic muscles, which support the bladder, may weaken. Generally, combinations of age, childbirth, bodyweight and hormonal factors can lead to this condition and increase the risk of problems with urinary incontinence or urgency feelings. Medications and constipation can also worsen symptoms.  

2. Change in pH-environment 

Lactobacilli bacteria normally present in the urinary tract create a low pH environment, which protects against infection. With age, the level of lactobacilli bacteria is lowered and so is mucus production. Levels of pH can rise, and the mucosa 

gets drier. This increases the risk of urinary tract infection, since the bacteria find it easier to attach and thrive. Infection (UTI) is also a risk for urinary incontinence. 

There are different kinds of bladder weakness due to menopause: 

Stress incontinence 

Urge incontinence 

Nocturia 

Painful urination and UTIs 

TENA products can be a great option when it comes to dealing with little leaks during the menopause. Discover the right one for you with this product finder. 

While urinary incontinence might be an inconvenient menopause symptom it also affects many aspects of life, significantly reducing the daily functioning associated with physical activity, intimacy and also work. However, here are certain treatments that you can undertake to hopefully help ease your signs: 

1. HRT for menopause

Hormone replacement therapy (HRT) replaces the hormones that decline during menopause. It’s commonly used to relieve most menopause symptoms and can be an effective treatment for hot flushes, night sweats, vaginal dryness, reduced sex drive and mood swings. It can also help prevent and treat osteoporosis, and heart disease which are an increased risk for postmenopausal women. 

“There’s a lot of fear around HRT, so my advice is stay clear of 'Dr Google', speak to your GP, do your research and make your own informed decision. For me, it’s been a lifeline. As helpful as HRT is, menopause has still been difficult to juggle with my responsibilities. I’ve cut back my hours, which is tough as a businesswoman, but it’s about tuning in to your body and listening to what it needs,” says Veena from the Menopause Monologues, who was given HRT patches and found her symptoms eased almost instantly.  

2. Oestrogen treatment

Local oestrogen treatment to the vagina in the form of creams, gels, tablets and vaginal pessaries is one way to manage menopause side effects, as these treatments provide increased delivery of blood to the tissue and reoestrogenise the tissues. Locally administrated oestrogen adds moisture, making the mucous membranes of the vagina and urinary tract thicker, more acidic and less delicate. It improves the mucus defence against infections, also reducing the risk of irritation and urinary tract infection. 

3. Pelvic floor muscle training

Since your pelvic floor muscles are important to improve bladder and bowel control and prevent leaks, it’s essential to keep up the strength in this muscle group. A few minutes of pelvic floor training (Kegel exercises) a day can reduce the risk of bladder issues during menopause, or even make them go away entirely. Also try the NHS “Squeezy app” or get a referral to a Women’s Health Physiotherapist for a further assessment and guidance to exercises.  

4. Natural remedies for menopause 

There are several natural treatments and herbs many women use to relieve menopause symptoms. These include Black Cohosh for the treatment of hot flushes, soy, flaxseed, and vitamins E and D. There is mixed scientific evidence for the effectiveness of these treatments, however some women find them helpful. Please check if you are on certain cancer therapies that they won’t interact with the supplements. 

Many menopause side effects can be treated by lifestyle changes such as healthy eating, taking supplements, including Vitamin D, and exercising regularly. Speak to your doctor to determine which treatment is right for you. First line treatment of menopause is a healthy diet and lifestyle. 

Sadly, reduced sex drive is often another sign of menopause. This is due to the lower oestrogen levels, which make the vaginal tissues thinner and drier – and can make sex painful. And lower testosterone levels can lower libido. However, this doesn’t mean that your sex life has come to an end. There are a few steps that you can take to stay sexually active during the menopause: 

1. Exercise: Physical activity increases your energy levels and boosts your mood, which might in turn increase your sex drive. 
2. Have sex more often. Interestingly enough, the secret to a more active sex life is to keep being intimate often. Having sex increases the blood flow to your vagina (as do pelvic floor exercise) and helps to keep the tissues healthy. 
3. Give yourself time to become fully aroused before sex. Moisture will help make sex more comfortable.  
4. Avoid products that irritate your vagina: Bubble baths and strong soaps are known to often cause irritations. 
5. Use moisturisers and/or lube: Lubricants will help make sex as enjoyable as possible by limiting the dryness. Moisturisers to the vagina should be used several times a week. Make sure moisturisers and lubricants are pH balanced (around pH 5) and without parabens, glycerine or any fragrance or other additives. Organic coconut oil can also be used on the labia and vagina as a moisturiser. 
6. Ask your doctors about possible treatments/exercises: HRT and pelvic floor exercises might increase your libido again. 

We hope that you found TENA’s guide on menopause symptoms, causes and how it links to incontinence helpful. Don’t forget to check out our full product range to help you manage menopause and urinary retention and to ask your GP or therapist if you’re struggling with menopause side effects, both physically and mentally.