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Verified BHUK Member
Posts: 4
Reply with quote  #1 
Hello, I am struggling with my bladder pain syndrome and even though taking D mannose, probiotics, no caffeine, careful diet etc I am struggling to know who to turn to for advise about the link between menopause/hormones and bladder pain syndrome. I wish I knew what to do for the best and which way to turn. I had my ovaries removed in 2010 and ever since then my problems have got worse. I take oestrogen pessaries but nothing else. I am reluctant to go to dr and ask about my options for taking additional HRT as I don't think her expertise and sympathy will be based on understanding what it is I need because of my bladder pain syndrome and hormone issues. If anyone is similar to my plight I would love to hear from you.

Posts: 1,088
Reply with quote  #2 
Why can hormones worsen incidences of UTI? Research shows that hormonal changes affect systemic conditions with flare-ups and remissions. Many UTI sufferers report that hormones certainly affect their symptoms during their monthly cycle, during pregnancy, and during perimenopause and menopause.

The Menstrual Cycle: The first day of your period is also day one of the menstrual cycle. Although both oestrogen and progesterone are at their lowest levels on day one, oestrogen begins to rise and continues to rise after menstruation. The rise in oestrogen levels thickens the uterus in preparation for fertilization. The rise in oestrogen also thickens the bladder lining during this time. Oestrogen levels reach their peak at ovulation, around day 14 of your cycle.

During the first two weeks of the menstrual cycle only a small amount of progesterone is present. However, after the egg is released during ovulation, oestrogen levels quickly decline and progesterone levels begin to rise in preparation for pregnancy. Although oestrogen levels also begin to rise again, they stay at a lower level than that of the first half of the menstrual cycle. During this second half of the menstrual cycle, oestrogen and progesterone levels reach a peak around the same time, about the third week of the menstrual cycle. If the egg released during ovulation has been fertilized the progesterone levels remain high. If the egg has not been fertilized both oestrogen and progesterone production drops quickly. The decline of progesterone levels causes shedding of the endometrium (the uterine lining), which begins a new menstrual cycle.

Unfortunately there appears to be no set pattern to hormone symptoms in those with bladder issues. Some experience an increase in swelling, pressure, pain, and frequency when oestrogen levels are highest. This is believed to happen because oestrogen increases mast cell secretion, therefore increasing inflammatory reactions. Others however feel better when their oestrogen levels are high. Researchers believe that bladder pain sufferers may benefit from the increase in the thickness of the bladder lining and the lack of progesterone during this time. To add to the complicated picture, another group feel best and experience less symptoms during their period, when hormone levels are low. Finally others experience bladder pain during their periods. Where sufferers can agree is that almost all complain of increased “flare” symptoms a few days prior to the onset of their period. The lower oestrogen levels and higher progesterone levels make people more susceptible to bladder symptoms around this time.

Many women will begin to suffer with infections when they become peri-menopausal (from around the age of 35 onwards), menopausal or have premature menopause. This can cause vaginal dryness and vaginal atrophy due to the thinning of the vaginal mucosal lining as a result of declining oestrogen levels. This urogenital thinning also affects the mucosal wall of the bladder allowing bacterial permeability. The walls of the vagina, urethra and bladder rely on oestrogen as one way to stay toned and able to manage the flow of urine from the bladder. With less oestrogen these organs lose tone and some degree of function.

Additionally, oestrogen (or estrogen) is needed for the vagina to maintain its natural flora and lubrication. The PH of the vagina is usually acidic but during these changes or when using oral contraception or IUD contraception, it can become alkaline leading to a rise in bacterial anaerobes, candida or bacterial vaginosis. The vaginal PH also changes shortly before and during menstruation and this is often when pre-menopausal women experience increased candida symptoms and anaerobe growth. Usage of tampons can cause prolonged vaginal PH issues during menses as the body is unable to naturally expel the menstrual blood which is itself alkaline.

If there is a suspicion that hormones are contributing to infection or symptoms, or you believe possible onset menopause or hormone deficiency are causing systemic issues, ask the GP for an oestrodial blood test. They will usually offer a Follicle Stimulating Hormone test (FSH), but insist on getting an oestrodial one as the FSH test results can come back within the ‘normal’ range whilst low oestrogen levels could be present. Ask for the results and discuss them with the GP or appropriate hormone specialist. Interestingly in a recent amendment to The National Institute of Clinical Excellence guidelines for HRT, it was noted that women over 45 should not be sent for blood tests to check for oestrodiol levels. This is because FSH and oestrodial fluctuates considerably over short periods during the years leading up to menopause and so blood levels are not a helpful addition to a clinical diagnosis.

Additionally, Progesterone and Testosterone levels should be checked as these too can impact on the bladder and general health. Whilst some women experience relief using oestrogen, others find relief using progesterone especially if oestrogen dominant, although this can sometimes cause frequency and nerve pain. Too much synthetic progesterone weakens the lining of the bladder, urethra, and vagina leaving them more susceptible to injury and inflammation. High levels of progesterone can cause frequent urination as progesterone acts like a diuretic. The sacral nerve which controls the pelvis and its organs is full of oestrogen receptors. A change in hormone levels may affect the excitability of the nerves and make you feel like you have to urinate more frequently. This may also be the reason for frequent urination during the second half of the menstrual cycle as progesterone levels are higher than those of oestrogen.

Testosterone after the age of 50 has been noted to reduce because of declining production within the ovaries. It is vital to bone density, muscle mass, energy levels, libido and general mood but is often overlooked with concentration on oestrogen and progesterone HRT supplementation.

During peri-menopause or menopause, hormone levels can fluctuate daily so blood tests should not be assumed to be the rule of thumb to determine hormone status. Go by symptoms such as:

a change in periods
vaginal/vulval dryness
vulval or vaginal pain
unusual vulval or vaginal bleeding
mood swings
hot flushes
memory lapse
increased levels of Thrush or Bacterial Vaginosis
frequency of urination or increase in UTIs
bone and joint pain.

These can indicate low hormone levels and must be mentioned to the GP or specialist when seeking advice. Keep a diary tracking daily and monthly symptoms.

Additionally, check family history, when did family members go through menopause? Is there a history of hormone/vaginal/urinary issues in the immediate family? Be your own detective and build a picture.

Another important element is DHEA, DHEA is the body’s natural cortisol antagonist. It prevents many of the negative effects of cortisol. Cortisol is secreted by the adrenal glands and is considered the “stress hormone.” It’s involved in several functions in the body including immune function and inflammatory response. DHEA is also secreted by the adrenals. It is also a precursor to oestrogen or testosterone (allowing conversion by the body into these hormones). Low DHEA, low oestrogen, high cortisol. Therefore the link between cortisol production and DHEA is an important one because, with long periods of chronically high cortisol levels due to stress or illness, the ability to produce DHEA diminishes and the immune system becomes compromised as well as oestrogen or testosterone production declining.

DHEA has been popular among perimenopausal women, seeking relief from menopausal symptoms, including decreased sex drive, diminished skin tone, and vaginal dryness. Studies have been mixed and more research is needed.

Preliminary studies show DHEA supplements raised levels of some hormones in postmenopausal women. People who believe in using DHEA claim that it relieves menopausal symptoms without increasing the risk of breast cancer or cancer of the lining of the uterus – unlike prescription hormone replacement therapy, which can increase risk of these cancers. But there is no proof that DHEA does not also increase risk of these cancers and research has shown a link in postmenopausal women with regard to breast cancer.

People with a history of cancer, or who are at high risk for cancer should not take DHEA without a doctor’s supervision. DHEA can be converted into either oestrogen or testosterone in the body, which may be dangerous for women or men with a history of hormone-sensitive cancers, such as breast or prostate cancer. Women with breast cancer tend to have low levels of DHEA in their bodies.

It is advised to seek out the very best hormone advice as HRT is prescribed in synthetic, bio-identical or natural formulations. Speak to specialists and research. Discuss with family any familial hormonal problems to make an informed decision. One size does not fit all and HRT can produce differing side effects. Medical history including family disease issues and any existing medical conditions must always be considered before a decision should be made about using HRT.

To further understand hormones and their importance the books ‘It Must Be My Hormones’ by Marion Gluck or “Screaming to be heard” by Dr Elizabeth Vliet are an excellent source of information.

For a detailed specialist list, Menopause Matters offers a search for a specialist facility and BHUK can also help with a listing of those seen by members.

For localised oestrogen treatment for the urogenital tract, Vagifem biofilm pessaries have been found to beneficial. They are entirely topical and will treat the vagina and bladder with minimal systemic absorption although some women still report symptoms despite the low dosage. They sit at the top of the vagina and there is no messy leak unlike other HRT topical treatments. Additionally, if fillers within a pessary are an irritant, the Estring can be used. This is a synthetic soft rubber ring which slowly releases oestradiol and can be introduced into the vagina and replaced at three monthly intervals. Topical creams such as Ovestin, Ortho Gynest or Premarin are also available. If there is a history of breast or uterine cancer within the family always discuss the appropriate usage of localised oestrogen therapies and any risks associated.

Those with Mast Cell issues may have problems with localized oestrogen as it can cause an increase in mast cell production and histamine release in the vaginal and bladder walls.

Verified BHUK Member
Posts: 91
Reply with quote  #3 
Wow! Wow! So informative!
Thanks for posting this Susan!

Posts: 189
Reply with quote  #4 
Excellent reply Susan .
I had a very bad uti a couple of months ago and wound up in hospital. My bloods showed a false positive pregnancy result so definitely another link to hormones. Can anybody comment on this link?

Posts: 14
Reply with quote  #5 
Hello [smile]

I’ve had fantastic success with HRT & oestrogen cream !!

My IC started in July, cut a long story short after seeing numerous specialists I am now under an amazing gynae who diagnosed ‘hypotrophic hypogonadism’ which meant due to low body fat my body wasn’t producing enough oestrogen therefore giving me the same horrid symptoms you get with menopause (mine would get significantly worse around the time leading up to my period).

I started on estrogen cream internally/ externally once a day which made my IC symptoms better by 80% (the constant bladder pain had gone, however I would still have psinful flares when eating the usual culprits!)

1 month ago I started using HRT topical oestrogen gel once a day & progesterone for the 1st ten days of the month, I have also cut the amount of exercise I do by half & forced myself to gain some weight in a bid to help balance my hormones naturally!!

In the last 2 days I have drunk a cup of coffee without prelief !!! I would say I’m 95% better now the only things I won’t eat / drink are citrus or fizzy drinks (still a bit scared of them !!!!)

I hope this helps [smile] let me know if you would like the details for the gynae ... I literally walked in the office with my bloods and he diagnosed me on the spot !!!!
He works in Dorset & London

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