The Surprising Connection Between Low Estrogen Levels and Urinary Incontinence

Urinary incontinence, the involuntary leakage of urine, is a common and often embarrassing condition that affects millions of people worldwide, particularly around 50% of women.

While many factors can contribute to this issue, one significant but frequently overlooked factor is the role of estrogen. Understanding the link between low estrogen levels and urinary incontinence can offer valuable insights for those affected and guide potential treatments.

Understanding Urinary Incontinence

Urinary incontinence refers to the involuntary leakage of urine, which can range from occasional dribbles to a complete inability to control urination. This condition can be particularly distressing, affecting one's quality of life, self-esteem, and social interactions.

There are several types of urinary incontinence, including stress incontinence, urge incontinence, overflow incontinence, and mixed incontinence. Each type has different underlying causes, but hormonal changes, especially in women, are a common thread.

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The Role of Estrogen in Urinary Health

Estrogen, a crucial hormone in the female body, plays a vital role in maintaining the health of the urinary tract. It helps keep the tissues of the bladder and urethra healthy and flexible, promotes proper blood flow, and ensures the strength of the pelvic muscles. During a woman's reproductive years, estrogen levels are relatively high, supporting these functions effectively.

However, as women approach menopause, their estrogen levels begin to decline. This hormonal shift can lead to a range of symptoms, including hot flashes, night sweats, vaginal dryness, and recurrent urinary tract infections (UTIs). Among these, urinary incontinence often emerges as a troubling issue.

How Low Estrogen Levels Lead to Urinary Incontinence

The decline in estrogen levels during menopause affects the urinary system in several ways:

  1. Thinning of Urethral and Vaginal Tissues: Estrogen helps maintain the thickness and elasticity of the urethral and vaginal tissues. When estrogen levels drop, these tissues can become thinner and less elastic, making it harder to control urination and increasing the risk of leakage.

  2. Weakened Pelvic Floor Muscles: Estrogen supports the strength of pelvic floor muscles, which play a crucial role in controlling the bladder. Lower estrogen levels can lead to weakened muscles, contributing to stress incontinence, where physical activities like coughing, sneezing, or exercising can cause urine leakage.

  3. Decreased Blood Flow: Estrogen promotes proper blood circulation to the pelvic region. Reduced estrogen levels can result in decreased blood flow, leading to the atrophy of the pelvic organs and tissues, further exacerbating urinary incontinence.

  4. Changes in Bladder Function: Estrogen influences the function of the bladder muscles and lining. Low estrogen levels can lead to an overactive bladder, resulting in urge incontinence, where there is a sudden, intense urge to urinate, often leading to leakage before reaching the bathroom.

  5. Increased Risk of Recurrent UTIs: Low estrogen levels can also alter the balance of the vaginal microbiome, making it easier for harmful bacteria to thrive. This increases the risk of recurrent UTIs, which can further irritate the bladder and worsen urinary incontinence.

Managing Urinary Incontinence Related to Low Estrogen

Understanding the link between low estrogen levels and urinary incontinence opens the door to effective management strategies. Here are some approaches that can help:

  1. Hormone Replacement Therapy (HRT): HRT can help replenish estrogen levels in the body, improving the health and function of the urinary tract. However, it's essential to consult a healthcare provider to understand what type and amount is best for you.

  2. Pelvic Floor Exercises: Strengthening the pelvic floor muscles through exercises like Kegels can help improve bladder control and reduce leakage.

  3. Lifestyle Modifications: Maintaining a healthy weight, staying hydrated, and avoiding bladder irritants like caffeine and alcohol can help manage symptoms.

  4. Medications: Certain medications can help manage symptoms of an overactive bladder and improve urinary control.

  5. Physical Therapy: Working with a physical therapist specializing in pelvic floor health can provide personalized strategies to strengthen the pelvic muscles and improve bladder control.

  6. Preventing UTIs: Maintaining good hygiene, staying hydrated, and potentially using vaginal estrogen creams can help reduce the risk of recurrent UTIs, thus minimizing their impact on urinary incontinence.

Exploration of effective programmes to strengthen the pelvic floor is vital given that 25–50% of women are unable to correctly activate their pelvic floor.

(National Library of Medicine)


Urinary incontinence is a multifaceted condition with various contributing factors, and hormonal changes, particularly low estrogen levels, play a significant role. By understanding this connection, women can take proactive steps to manage their symptoms and improve their quality of life. If you are experiencing urinary incontinence or recurrent UTIs, consult with a healthcare professional to explore the best options for your individual needs.


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  • Firstly, the reason for this blog is because so many women do NOT even know that they are perimenopausal, and are suffering in silence.

    Thank you for saying I am young. Appreciate that. But, I should point out that I am 45 and at 44 I asked for HRT as I was experiencing dreadful symptoms. The hot flushes were awful and my mood was so low. Thankfully, I, unlike many women (as I have said before), do know the symptoms of perimenopause and I still got fobbed off by doctors and refused HRT as I " was too young!"

    I eventually had a blood test done that showed my estrogen levels were extremely low. So, I was very angry to think how many women would just have accepted this ‘womens health expert Drs’ diagnosis and would not have been adamant that blood tests were done and continued to suffer alone.

    Another reason for this blog was that so many women get repeated UTIs and are given antibiotics when in fact it could be pelvic floor dysfunction. Once again, many women do not know the difference, or that there could be another reason. (I have also done a blog on this to help women understand the difference).

    Once again, ‘most’ women may not be aware that we have estrogen receptors all over our body and that estrogen can be applied around and into the vaginal area to help with incontinence issues.

    I have also helped many many women who suffered (some for years) with vaginal atrophy and thought that just because they were postmenopausal and believed that this ‘was normal’!

    After reading one of my blogs they reached out to their Dr and was prescribed estrogen for the vagina and within even a few days the symptoms were so much better and they were so thankful to have found my article.

    So, on the final point – No, not all postmenopausal women will get incontinence issues. One sure way to help avoid it is to be doing your Kegels two to 3 times every day and understanding the vital importance that estrogen has on our pelvic floor, vaginal tissues etc.

    I will continue to do my best in providing educational blog topics every week and I always welcome constructive feedback.
    But, please do rest assured that I take women’s healthcare extremely seriously and I am very proud 🧡 of the many women I have helped improve their pelvic floor strength, the women I have helped push for HRT even though they were told they ‘were too young’, the women who now no longer suffer with vaginal atrophy, and even the few who went to see their doctor after I posted about getting seen for a breast lump. X

    Julie, Founder & Campaigner of Secret Whispers
  • What is surprising is precisely the adjective “surprising” in the title of the post. Anyone who knows anything about incontinence knows that menopause causes most incontinence cases and that they are the most difficult to improve, precisely because of the lack of estrogens. This article makes me doubt the seriousness of the author, as well as the treatments she offers. Being young is no excuse for not knowing the reality of postmenopausal women. Because sooner or later, it will happen to all of us (yes, to you too) and you will feel the frustration of being ignored because everything is dedicated to women with young children.


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