The Bladder and Menopause: Understanding the Connection

Hormonal changes during menopause, particularly declining oestrogen levels, can significantly impact vaginal and bladder health. These changes can lead to several uncomfortable and potentially harmful conditions that many women experience as they transition through menopause.

Hormonal Imbalances and Vaginal Health

Oestrogen imbalance can cause the vaginal skin to become thinner and reduce cervical fluid lubrication. These changes may alter the microbial balance of the vagina. Additionally, life stages, stress, and exposure to hormone-disrupting chemicals or medications can further impact vaginal health.

The Role of Blood Sugar in Vaginal and Bladder Health

Fluctuating blood sugar levels, such as those experienced in diabetes or insulin resistance, can compromise immunity, making it easier for bacteria or fungi to overgrow. Managing blood sugar levels through a balanced diet can help mitigate these risks and promote overall health.

Urinary Tract Infections (UTIs) and Their Impact

Urinary tract infections (UTIs) are prevalent, affecting approximately 50% of women, with 20-30% experiencing recurrent episodes. UTIs can be painful and may lead to serious complications like pyelonephritis and kidney infections.

While antibiotics are the primary treatment for UTIs, recurrence is common. This may be due to an overlooked factor—the bladder's microbiome. Recurrent UTIs can result from ascending infections (bacteria traveling up the urethra) or indwelling infections where microbes reside in the bladder. Factors such as immune changes, dietary issues, or physical trauma may trigger these infections.

The Vaginal Microbiome and Its Role in Health

The vaginal microbiome is a dynamic ecosystem that changes throughout a woman's life. In premenopausal women, oestrogen levels encourage glycogen accumulation in the vaginal walls, promoting dominance by Lactobacillus species. This creates an optimal environment with a healthy pH balance.

However, as oestrogen declines in peri- and postmenopausal stages, glycogen levels reduce, leading to a decrease in Lactobacillus abundance. This shift increases vaginal pH and may thin the vaginal walls, causing symptoms such as:

·       Vaginal atrophy

·       Pain during intercourse (dyspareunia)

·       Painful urination (dysuria)

·       Other genitourinary symptoms of menopause (GSM)

Genitourinary Syndrome of Menopause (GSM)

GSM affects roughly 50% of postmenopausal women and can significantly impair sexual function, comfort, and overall quality of life. Studies have linked vaginal microbiome changes to GSM, indicating that diverse microbiota with reduced Lactobacillus levels may correlate with vaginal atrophy symptoms.

Menopause and Metabolic Changes

Menopause is also linked to increased central adiposity (abdominal fat gain), which contributes to insulin resistance. A study involving 33 women aged 45-60 explored adipose tissue inflammation and morphology, highlighting the connection between hormonal shifts and metabolic changes.

Conclusion

Understanding the relationship between menopause, vaginal health, and bladder conditions is essential for managing symptoms and maintaining overall well-being. Managing hormone levels, supporting a healthy microbiome, and maintaining balanced blood sugar levels can play crucial roles in improving health outcomes for menopausal women.

With recurrent and persistent UTIs it is worth considering a urinary microbiome test where offending microbes that may be at play can be identified and how robust the lactobacillus colony is. Here a personalised protocol can be applied with targeted probiotic strains and natural supplements, nutrition and lifestyle can be implemented to strengthen the immunity of the urinary tract and make it more resilient.

1.        Abildgaard J, Ploug T, Al-Saoudi E, Wagner T, Thomsen C, Ewertsen C, et al. Changes in abdominal subcutaneous adipose tissue phenotype following menopause is associated with increased visceral fat mass. Sci Rep [Internet]. 2021;11(1):1–12. Available from: https://doi.org/10.1038/s41598-021-94189-2

2.        Brotman RM, Shardell MD, Gajer P, Fadrosh D, Chang K, Silver MI, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2018;25(11):1321–30.

3.        Gliniewicz K, Schneider GM, Ridenhour BJ, Williams CJ, Song Y, Farage MA, et al. Comparison of the vaginal microbiomes of premenopausal and postmenopausal women. Front Microbiol. 2019;10(FEB):1–9.