Urinary incontinence in menopause: why the type changes

Urinary incontinence in menopause is often put down to the menopause itself, and that is only half right. A review setting the literature side by side concluded there is no conclusive evidence for a specific increase in urinary incontinence around menopause (PMID 36690015). What does increase is age, and that climbs in an almost straight line.

So less changes than you think, and at the same time something more important does.

What genuinely shifts is the type. And that is exactly the part deciding what happens in the consulting room, and the part no page on this subject stops at.

Does menopause change urinary incontinence?

The type changes; the number of women affected mainly rises with the years. Before menopause, leaking on exertion is the most common: coughing, sneezing, lifting or jumping. After menopause, urgency incontinence and the mixed form become more common (PMID 36690015).

From leaking when you sneeze to not making it in time.

That distinction is not academic. Leaking on exertion points to the support of your pelvic floor and sphincter. Urgency points to your bladder muscle, contracting sooner than you want it to. The two feel different, arise differently and are approached differently.

Systematic reviews setting menopause and incontinence side by side find an association running largely through age and other factors (PMID 39525118). More recent work on prevalence and daily-life impact shows the complaint is common and affects quality of life considerably (PMID 40279983).

Look at the last row. Urgency arriving on a fixed cue, such as coming home or running water, is characteristic enough to point the way immediately in the consulting room. That detail is worth mentioning.

Does hormone therapy help this?

With systemic oestrogen, more likely not, and that surprises almost everyone. The same review reports that women given systemic oestrogen, with or without a progestogen, are more likely to develop incontinence or see it worsen (PMID 36690015).

That is the reverse of what you read online.

The distinction that counts here is systemic versus local. Systemic means throughout your body, via a tablet, patch, gel or spray. Local means given vaginally, where it mainly acts in the tissue there. A European guide to managing incontinence after menopause treats those two separately for that reason (PMID 33008675).

I think this could be said more often. Not because hormone therapy is wrong, which is not what this is about, but because incontinence is not a reason to start it and not in itself a reason to stop. That conversation belongs with your GP or gynaecologist. The different forms are in menopause hormone therapy, and the local variant in Vagifem for vaginal dryness.

What else belongs to this pattern?

Vaginal dryness, pain during sex and recurring bladder infections. Those complaints come from the same tissue: your urethra, bladder neck and vaginal wall all respond to oestrogen. They are therefore often named together.

One area, several complaints.

Recurring bladder infection is the important neighbour here, because it gets confused with urgency. Burning when you pass urine belongs to an infection; urgency without burning usually does not. Why those infections keep returning in this phase is in recurring bladder infections in menopause.

Take two women of 54. One leaks a little when she sneezes, has done since her second birth, and nothing has changed. The other always used to make the toilet and now goes twice a night, with urgency arriving out of nowhere. Same complaint name, two different stories and two different workups.

Which blood values are useful here?

For incontinence itself, none. No blood value establishes or explains it, and that is more honest than pretending a hormone result answers this. What is happening sits in tissue and muscle function, not in your blood.

Urine says more here than blood does.

On suspicion of a bladder infection it is urine testing, not blood testing. Where blood does add something is to the question of where you stand hormonally, or with symptoms that could point elsewhere. A menopause check looks at FSH and oestradiol, a women's hormone panel at the wider picture.

What your GP does with this is up to your GP. None of these results determines which type of incontinence you have.

When do you go sooner?

For blood in your urine, even once and even without pain. That always gets checked and is not a menopause symptom. Dutch GP guidance on incontinence in women and public patient guidance name a few further situations.

Three things do not wait.

Incontinence starting suddenly, with no build-up. Incontinence with fever or pain in your side. And incontinence with weakness, tingling or altered sensation in your legs or buttocks.

Vaginal bleeding after menopause is a separate story sometimes confused with this, and that too always gets checked. Why is in bleeding after menopause.

What do you take to your GP?

Three things, and the first does most of the work. Whether the leaking comes on exertion or on urgency. How often you go by day and by night. And how much it limits you, in terms of what you no longer do.

Two days of tracking says more than an estimate.

Note the time each occasion, whether there was leakage, and what you were doing at that moment. That picture usually makes the difference between exertion and urgency obvious at a glance, and it is exactly what otherwise has to be reconstructed in the consulting room. For the wider picture of this phase, navigating perimenopause is the starting point.

References

1. Milsom I. Does the climacteric influence the prevalence, incidence and type of urinary incontinence? Climacteric. 2023;26(4):324-330. PMID 36690015.
2. Allafi AH, et al. The link between menopause and urinary incontinence: a systematic review. Cureus. 2024;16(10). PMID 39525118.
3. Russo E, Caretto M, Giannini A, et al. Management of urinary incontinence in postmenopausal women: an EMAS clinical guide. Maturitas. 2021;143:223-230. PMID 33008675.
4. Yakit Ak E, et al. Menopause, urinary incontinence prevalence and impact on healthy living. Eur J Obstet Gynecol Reprod Biol. 2025. PMID 40279983.
5. Dutch College of General Practitioners (NHG) guideline on urinary incontinence in women (M46). Available via richtlijnen.nhg.org.
6. Thuisarts. I leak urine. Available via thuisarts.nl.
7. RIVM. Statistics on incontinence in the Netherlands. Available via rivm.nl.

Every blood test result at Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.