What do urinary symptoms feel like in menopause?

During menopause, many women notice they go to the toilet more often than before, that the need to pee comes suddenly and will not wait, or that they wake up at night to pee. Among menopause symptoms, the NHS lists needing to pee more often, including at night, sometimes losing bladder control (incontinence), and getting urinary tract infections more often or having pain and burning when peeing (NHS, Menopause: symptoms).

The Menopause Society lists the urinary symptoms that can come with estrogen loss as follows (The Menopause Society, Symptoms):

  • Needing to pee more often
  • Urgency: a sudden, strong need to pee, sometimes with leaking
  • Nocturia: waking two or more times a night to pee
  • A higher risk of urinary tract infections

Why does menopause make you pee more often?

The vagina, the bladder and the urethra (the tube that carries urine out of the body) are tissues that sit close together and are affected by estrogen in similar ways. As estrogen falls in menopause, these tissues become thinner and drier and lose their elasticity. The Menopause Society groups these vaginal, vulvar and urinary symptoms together under the name genitourinary syndrome of menopause (GSM). Burning when peeing, needing to pee often or urgently, and a higher risk of urinary tract infections can be part of this syndrome (The Menopause Society, MenoNote: GSM).

The NHS also lists having been through menopause among the things that raise the risk of urinary tract infections (NHS, Urinary tract infections).

Vaginal dryness and pain during sex can have the same cause; we cover this in vaginal dryness and low libido.

Does frequent urination in menopause go away on its own?

It is common, but it is not something you “just have to put up with.” According to The Menopause Society, unlike hot flashes, GSM symptoms usually do not ease over time; when they are not treated, they often get worse (The Menopause Society, MenoNote: GSM). So rather than waiting for the years to pass, it makes sense to ask for an assessment.

What types of bladder leakage happen in menopause?

The NHS classifies urinary incontinence as follows (NHS, Urinary incontinence):

  • Stress incontinence: Leaking when you cough, sneeze, laugh or lift something heavy, that is, when pressure is put on your bladder. It is usually linked to weakened pelvic floor muscles (the group of muscles that holds urine in).
  • Urge incontinence: Leaking with or just after a sudden, strong need to pee. It is usually linked to an overactive bladder muscle.
  • Mixed incontinence: Stress and urge incontinence together.
  • Overflow incontinence: Frequently leaking small amounts because the bladder cannot empty fully. It is often linked to a blockage in the urinary tract.
  • Total incontinence: When the bladder cannot store urine at all.

According to the NHS, the factors that raise the risk of incontinence include pregnancy and vaginal birth, excess weight, family history and older age (NHS, Urinary incontinence). Knowing which type you have makes it easier to talk to your clinician.

What else can cause frequent urination?

Frequent urination is not always linked to menopause. A urinary tract infection also causes frequent and sudden need to pee. According to the NHS, the symptoms of an infection are pain or burning when peeing, needing to pee often or suddenly (including at night), cloudy pee, blood in your pee, lower tummy pain, a high temperature and feeling unwell (NHS, Urinary tract infections). Dark or strong-smelling pee on its own may only be a sign that you are not drinking enough.

A high temperature, pain in your back just below the ribs, shivering and blood in your pee can suggest a kidney infection. Because a kidney infection can spread to the blood, it needs to be assessed quickly (NHS, Urinary tract infections).

Drinking a lot of water, caffeine and alcohol also increase the amount of urine and can irritate the bladder (NHS, Urinary incontinence).

Recurrent urinary tract infections

According to the NHS, having two urinary tract infections in six months or three in twelve months counts as recurrent infection. In that case it is advisable to see your GP; your GP can consider different options or refer you to a specialist. If symptoms continue after treatment, asking for a specialist referral is also an option (NHS, Urinary tract infections).

The NHS’s general prevention tips include (NHS, Urinary tract infections):

  • Wiping from front to back after using the toilet
  • Drinking enough fluids that your pee stays pale
  • Peeing soon after sex
  • Not holding in your pee for a long time and not rushing on the toilet
  • Wearing cotton underwear and avoiding tight clothes and perfumed soaps

These tips will not always prevent an infection, but they are general steps aimed at lowering the risk.

General lifestyle information

For bladder leakage, the NHS lists the following steps at a general level (NHS, Urinary incontinence):

  • Pelvic floor exercises: Exercises that aim to strengthen the muscles that control the flow of urine by squeezing and relaxing them. Because doing them correctly matters, it is good to learn how from a health professional.
  • Bladder training: Aims to gradually lengthen the time between feeling the need to pee and going to the toilet.
  • Cutting down on caffeine and alcohol: Tea, coffee, cola and alcohol can irritate the bladder and increase the amount of urine.
  • A healthy weight: Excess weight is one of the known risk factors for incontinence.

These steps do not work the same way for everyone; talk to your clinician or physiotherapist about which ones suit you.

What can you track yourself?

The NHS says your clinician may ask you to record how much fluid you drink and how often you pee (NHS, Urinary incontinence). For a few days, note:

  • The type and rough amount of fluid you drink during the day
  • How many times you pee during the day and at night
  • Whether you have sudden urgency or leaks, and if so, what you were doing at the time
  • Symptoms such as burning, pain, cloudy pee or blood
  • The dates of any urinary tract infections you have had

If you also want to see other menopause symptoms, you can look at menopause symptoms.

When and which doctor should you see for frequent urination?

The NHS advises seeing a clinician for any kind of incontinence and stresses that it is a common problem you should not feel embarrassed to talk about (NHS, Urinary incontinence). If you have symptoms of a urinary tract infection and you are 65 or over, have diabetes, have a weakened immune system or your symptoms are getting worse quickly, you should contact your clinician the same day (NHS, Urinary tract infections).

Which specialty? The first step is often your family doctor (GP). If needed, you will be referred to a gynecologist or a urologist. Some hospitals also have urogynecology clinics that combine these two fields. You may also be referred to a physiotherapist for pelvic floor exercises.

Questions you could ask:

  • Are my symptoms an infection, or a change linked to menopause?
  • Which type does my bladder leakage fit?
  • Would you like me to keep a bladder diary?
  • What options are there for my recurrent infections?
  • Are pelvic floor exercises or bladder training suitable for me?

This page does not describe treatment options. Talk to your clinician about the options that suit you.