How Perimenopause and Menopause Affect Your Bladder – What Women Should Know.
By: Lisa Wragg
26 March 2026
Essentials
What Is Perimenopause and Menopause?
All women will experience perimenopause and menopause in their lifetime, yet many still do not fully understand what these stages are, or the emotional, physical and mental changes they can bring during midlife.
So, what is the difference between perimenopause and menopause and when does it start?
The “perimenopause” or “menopause transition”, is the time from the onset of menstrual cycle changes until one year after the final menstrual period. A woman is postmenopausal 12-months after her final menstrual period, which then signals the beginning of the menopause period transition for women.
The menopause transition commonly starts around 47-years and the average age of natural menopause is 51-years. The diagnosis of menopause is clinical, based on cessation of menstruation for a period of 12 months.
However, not every woman’s hormones and transition operate the same, so the ages at which women transition can vary.
Hormonal Changes and the Onset of Urinary Symptoms
During perimenopause and menopause there is a decline in oestrogen levels which can lead to changes in the genitourinary tract where a woman may suddenly start to experience the onset of urinary urgency, stress urinary incontinence, urinary urge incontinence, altered sexual function and the development or worsening Pelvic Organ Prolapse or an increase incidence of urinary tract infections (UTIs).
Collectively, these urinary symptoms are referred to as the genitourinary syndrome of menopause GSM.
Understanding the Lower Urinary Tract System
The lower urinary tract system (LUTS) includes the bladder and bladder neck, the urethra, the urethral sphincter and the pelvic floor muscles. These parts work together as your continence mechanism, relying on a carefully coordinated nervous system. This system keeps the pressure in your urethra and urethral sphincter higher than in your bladder, so the urethra stays closed while your bladder fills, helping you stay in control.
The Role of the Female Urethra
The female urethra is 3-5 centimetres long and plays the role within the continence mechanism of carrying urine from the bladder to outside the body. The lumen of the urethra is a convoluted ribbon-like structure that only dilates during urination, or when accommodating a urethral catheter.
The urethra is lined with a mucosal layer containing thick layers of epithelium, creating a mucosal seal. There is also a vascular layer rich in blood vessels and dense connective tissue. Smooth muscle runs along the urethral wall and skeletal muscle circles the mid-urethra. Oestrogen receptors are located throughout this tissue, ensuring a thick mucosal seal and contributing to a strong urethra with healthy vascular pressure and dense collagen fibres.
The Impact of Declining Oestrogen
With a decline in oestrogen levels during perimenopause and menopause the thickness of the urethral mucosal seal and lubrication causes the urethra to open more readily with any increase in intra-abdominal pressure along with a weaking of the pelvic floor musculature.
In conjunction with decreased oestrogen levels weight gain, constipation, past obstetric history, lifestyle choices and other medical conditions will also influence the development of incontinence. Regardless of the severity of symptoms, urinary incontinence can have a substantial effect on a woman’s psychological, social, sexual health and wellbeing.
The Good News – Support Is Available
The good news is that help, support and treatment is out there and no woman is alone!
In Australia, public health continence services offer holistic continence assessments through a compassionate, multidisciplinary team of experts, including Nurse Continence Specialists, Pelvic Health Physiotherapists and Continence Physicians. These clinicians work together to provide comprehensive continence management programs, tailored to each woman’s individual needs, completely free of charge.
The exact program will be guided by diagnostic assessments of the bladder, bowel, pelvic floor muscle function and vaginal health. While every program is personalised, they all focus on supporting healthy bladder, bowel, and pelvic floor function through practical, empowering and supportive strategies.
General Continence Management Strategies
- Good fluid intake – water is the best choice and being mindful that alcohol and drinks containing caffeine (such as coffee, tea and cola) can irritate the bladder
- Good food choices – where the diet consists of a variety of food groups, particularly plant foods with high fibre, such as wholegrains, vegetables, fruit and legumes (beans) and nuts and seeds
- Stay active to maintain a healthy weight, to reduce stress and anxiety and to improve sleep hygiene
- Learn how to do pelvic floor muscle friendly exercise programs once you have established how to do pelvic floor muscle exercises either with a nurse continence specialist or pelvic health physiotherapist
- Use water or non-soap washes to gently cleanse your vulva and anal areas to prevent further vaginal irritation and dryness
- Avoid going to the toilet ‘just in case’ as this can reduce how much urine your bladder can hold over time
- Sexual intercourse may be uncomfortable or even painful, consider the use of vaginal lubricants or moisturisers or your doctor may prescribe topical oestrogen for you to manage your genitourinary syndrome of menopause GSM
- Local vaginal oestrogen treatment is available in the form of pessary, tablet, cream and ring, with no significant differences between these formulations. However, please discuss with you prescribing doctor or nurse practitioner prior to use.
- Continence products may be necessary, but the choice can be daunting as there is a such a huge range of products available, however, many people are using the incorrect product for their needs which can be cost prohibitive ongoing and a nurse continence specialist can offer assistance and advice.
Lisa Wragg
Nurse Continence Specialist
Lisa Wragg has 35 years of experience as a “hands on” Nurse Continence Specialist in continence assessment, management and advocacy committed to enhancing community awareness and access to continence services throughout Australia.
She has contributed extensively to this area of medicine, authoring multiple publications and chairing multiple advisory groups relating to the development and review of continence health and aged care standards of care, nursing policy, resource information, online education programs, credentialing and customer care service delivery models for continence and urological care.