Bladder weakness & urinary tract infections, the taboo topics

Over 50% of women suffer from urogenital problems during menopause. Dr. med. univ. Nicole Weirich informs about causes and solutions

For many women, menopause brings with it profound physical changes, particularly due to the decline in the female sex hormone estrogen. Urogenital complaints are among the most common side effects of this phase of life and can significantly impair quality of life. Dr. med. univ. Nicole Weirich, urologist, and expert in hormone replacement therapy (HRT), provides insights into typical complaints, their causes, and possible treatment methods.

Dear Nicole, you have specialized in menopause. How did that come about?

N: In my practice, I have noticed that many women suffer from urogenital problems during menopause, but are often afraid to talk about it. Unfortunately, this topic is still associated with shame and taboos. It is important to me to educate women and show them that help is available.

What are the most common urogenital complaints during menopause?

N: The hormonal changes during menopause can manifest themselves in many different ways. A persistent lack of estrogen affects both the female sexual organs and the urinary tract. The skin of the vagina becomes thinner, which can increase pain and soreness. The risk of bladder and urethral infections also increases.

• Cycle changes: During perimenopause, the menstrual cycle may become irregular, with bleeding more frequently, less frequently, heavier, or lighter, until periods eventually stop altogether. Some women also report extremely heavy bleeding.
• Vaginal dryness and vaginal atrophy: A lack of estrogen leads to reduced blood flow to the vagina, which can cause vaginal dryness, itching, burning, and pain during intercourse. Vaginal atrophy describes the thinning of the vaginal tissue, which is associated with an increased risk of infections.
• Cystitis: Cystitis occurs more frequently during menopause because the changed vaginal environment and thinning mucous membranes make it easier for bacteria to penetrate. This can lead to recurring cystitis. Sometimes only hormone therapy or targeted phytotherapy through a change in diet can help.
• Urinary tract problems: Hormonal changes weaken the bladder and pelvic floor muscles, which can lead to frequent urination or even urinary incontinence. Women often report involuntary urination, for example when laughing, coughing or lifting heavy objects. Sleep disorders are also caused not only by hot flashes, but often also by a weakened bladder.
• Uterine prolapse: The uterus can prolapse during menopause, which can be very painful. This happens when the muscles and ligaments that hold the uterus in place are weakened. Risk factors include childbirth, obesity and hormonal changes.

What treatment options are there?

N: There are various approaches to alleviate the symptoms:

Hormone replacement therapy (HRT): Systemic HRT compensates for the hormone deficiency and can improve many symptoms. For women who prefer a low-risk treatment, local estrogen therapy in the form of creams, suppositories or vaginal rings is an option.

Pelvic floor training: Targeted exercises strengthen the pelvic floor muscles and help with urinary incontinence. Many physiotherapy practices and fitness studios offer appropriate courses. Breathing also plays an important role, for example in Kundalini Yoga, where breathing and movement are combined.

Biofeedback: EMG biofeedback therapy centrally trains and strengthens the muscles that control the retention of urine flow

Herbal preparations (phytotherapy): Alternatives such as black cohosh or red clover can help alleviate symptoms.

Aids for bladder weakness: In cases of mild incontinence, special incontinence pads can offer a solution. These bind urine better than conventional panty liners and prevent unpleasant odors.

Pessary for uterine prolapse: A pessary is a plastic insert that is inserted by the gynecologist or urologist and pushes the uterus back up.

Tools:

Incontinence tampons:  instead of absorbing fluid, they apply pressure to the front wall of the vagina, supporting the bladder and restoring the natural closure function of the urethra.

Special pads and panties

Hygiene: In case of cystitis: Clean the intimate area after each visit to the toilet with lukewarm water

Warmth and drinking lots of herbal tea flush the bladder and prevent germs from settling

Vitamin C: cranberries, raspberries, blueberries and currants

mannose sugar

Vaginal laser therapy: In cases of vaginal atrophy, laser therapy can help regenerate the vaginal lining and relieve symptoms.

"Talk openly with your doctor about your symptoms. There are many effective ways to improve your quality of life. I would also like to emphasize here that hormone replacement therapy can also be an option for urogenital complaints."

What else can affected women do?

N: A holistic approach is important. The issues listed here are hormonal, which means you can actively influence them. Hormones change daily through our activities and our nutrients.

You are trained in Ayurveda, what fascinates you about this method?

N: Ayurveda is a natural healing method that is thousands of years old and has been extremely well-researched. In Ayurveda, there are different types (doshas) - Vata, Pitta, Kapha and the mixed types. These can also change over time.

What fascinates me is that knowing what type you are can be extremely effective in adjusting your diet and lifestyle.

Women who tend to have a pear-shaped figure (love handles, fat bottom) are usually Kapha types. This means that they should eat a light, warm diet and incorporate plenty of exercise into their daily routine. Women who gain weight quickly often have increased estrogen levels, as fat can be converted into estrogen.

How do I find out what type I am?

N: I can see it in women, figure plays a role, fat deposits, but also sensations of cold, but also temperament. Are you easily irritated or are you more of a calm type? There are various ways to determine your own Ayurveda type:

• Ayurveda tests: There are numerous tests that can help you find out your dominant dosha (Vata, Pitta or Kapha).
• Ayurvedic consultation: A detailed consultation takes into account not only your physical characteristics but also your mental and emotional characteristics.
• Self-observation: Pay attention to your physical and mental characteristics. Do you tend to have a certain body type? How do you react to cold or heat? What is your temperament?

Ayurveda as a holistic treatment option during menopause

N: Ayurveda offers many ways to support the menopause. Ayurveda works a lot with herbs, both internally and externally. Aromatic oils stimulate the senses, and oil massages increase blood flow to the skin and reduce stress. Spices support the diammikobiome.

• Herbs: Various herbs are used in Ayurveda to balance hormonal changes and relieve typical menopausal symptoms. Examples include Shatavari, Ashwagandha, and Turmeric.
• Aromatic oils: Essential oils such as lavender, rose or sandalwood have a calming and balancing effect. They can be used in aroma lamps, as massage oil, or in baths.
• Massages: Ayurvedic massages with warm oils promote blood circulation, relieve tension, and reduce stress.
• Nutrition: A balanced diet based on Ayurvedic principles supports digestion and the immune system. Spices such as ginger, cumin, and coriander have a warming and digestive effect.

Do you have any advice you would like to give to women going through menopause?

It is important to see health in a holistic way. Women affected should be aware of their bodies and their health. A healthy lifestyle, stress management, and holistic approaches such as Ayurveda can help to experience menopause as a positive phase of change. For this reason, I believe that hermaid is a good initiative that I want to support as a doctor.

Conclusion

Urogenital complaints during menopause are not uncommon, but women do not have to accept them. With the right treatment, be it HRT, pelvic floor exercises or herbal remedies, many symptoms can be alleviated and quality of life improved.

Buche ein Beratungsgespräch

Dr. med. univ. Nicole Weirich begleitet Frauen auch in Onlinesprechstunden bei hermaid. Du kannst ein Einzelgesprächen buchen.

Ihre Schwerpunkte sind:
- urologische Themen: Blasenschwäche, Harnwegsinfekte
- Beckenboden
- Hormon-Ersatz-Therapie (HRT)
- Nährstoffe
- Healthy Aging
- Ayurvedische Medizin

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Autorin: Susanne Feldt