Author: Dr. Ada Ozoh

Bladder irritation is a common symptom associated with menopause. With declining levels of estrogen, the bladder lining becomes very thin and prone to irritation and infection. There may also be burning pain on urinating and difficulty in holding back urine. Estrogen is responsible for maintaining the lining of the bladder and promoting its blood supply and nutrition.

Bladder Overview

The urinary bladder is an elastic, muscular sac which holds the urine excreted by the kidneys before urination. Once it collects 300cc of urine, it starts sending signals for urination, and can hold a maximum of 600cc in normal adults.

One type of bladder disorder is the overactive bladder, also known as urge incontinence. This is the involuntary voiding of urine after a sudden urge to urinate is felt. Overactive bladder is often caused by the abnormal contraction of the detrusor muscle, one of the bladder’s major muscles involved in the normal process of urination.

Cases of overactive bladder are higher in women than in men, and more common as people age. However, it is not a part of the normal aging process and should be given medical attention.

Causes of Overactive Bladder

The nervous system regulates the contraction and relaxation of the detrusor muscle. The following diseases may affect the Detrusor muscle’s normal function, causing inappropriate contractions which force the urine out:

• Parkinson’s Disease,
• Multiple Sclerosis,
• Spinal Cord Injury,
• Diabetic Neuropathy,
• Dementia and
• Stroke
• Bladder stones or tumorsIn addition, there can be other factors that may result in symptoms similar to those of an overactive bladder. Therefore, careful assessment is needed to differentiate the disorder from these underlying conditions:
  • Urinary tract infections
  • Poor renal function
  • High fluid intake
  • Excessive consumption of alcohol and caffeine
  • Medications such as diuretics

  Symptoms of Overactive Bladder

  • Urinary urgency and incontinence regardless of the amount of urine
  • Frequency of urination, about 8 or more times per day
  • Nocturia, or waking up three or more times at night to urinate

  Treatment

  Overactive bladder is not a socially- accepted condition, and may cause depression, poor social interaction, and interrupted sleep patterns, thus affecting quality of life. The fear of not making it in time to the toilet may cause disruptions in daily activities. Depending on the severity and the individual’s capability, treatment protocols may be behavioral, medical, and surgical.
  • Kegel exercises: Typically included in the treatment plan, these involve exercises that strengthen the pelvic floor to prevent incontinence, done 30- 80 times daily for at least 8 weeks.
  • Pelvic floor electrical stimulation: Done in conjunction with Kegel, this therapy sends mild electrical impulses to facilitate pelvic muscle contractions.
  • Vaginal weight training: This therapy is performed by tightening vaginal muscles to hold weights placed within the vagina, done twice daily for 15 minutes within a period of 4- 6 weeks.
  • Bladder retraining is a behavioral therapy used to increase voiding intervals and resist urgency.
  • Regular bladder emptying and scheduled toileting can promote routine voiding and prevent leakage.
  • Encourage use of toilets instead of relying on diapers and underpads.
  • Avoiding spicy foods, chocolates, nuts, alcohol, caffeinated beverages, and too much fluid may limit symptoms of overactive bladder. Maintaining a normal weight can also reduce stress on the bladder and lessen feelings of urgency.
  • Anticholinergics are medications that may be used to decrease activity of the Detrusor muscle.
  • Reconstructive bladder surgery is a common surgical procedure to treat overactive bladder, but surgery should be a last option unless patient is unresponsive to other forms of therapy and manifests debilitating symptoms.

As menopause approaches, the levels of estrogen gradually decline.
When ovulation stops and all the ovarian follicles have disappeared , the supply of estrogen from the ovary stops. The only estrogen available to the body is from the androgens, sex hormones that the adrenal gland produce. The androgens are then converted into estrogen by the fat cells (among others) in the body.

There are 3 types of estrogen in the body:

1. estradiol
2. estrone
3. estriol

Estradiol is the most potent and estriol is the weakest.

Estrogen treatment for bladder irritation

Estrogen treatments for bladder irritation are available in various forms:

1. Oral estrogen – this can improve bladder symptoms like burning and incontinence. However this is not the best option for women who cannot take estrogens for health reasons (e.g. a hitsory of breast cancer). Some women do not get relief from oral estrogen and so may find relief from other forms.
2. Topical estrogen –
   • estrogen patch – the estrogen in the patch is absorbed through the skin and into the bloodstream. This usually causes fewer side effects compared to oral estrogen. However, the adhesive that sticks the patch to your skin can cause irritation if you are allergic to it.
   • vaginal estrogen – this is available in the form of creams, gels, a vaginal ring e.t.c. This is the best option for you if you are targeting bladder and/or vaginal symptoms in particular.

As much as possible, try to use natural/bioidentical estrogen as it tends to have fewer symptoms.
If you are having bladder irritation and you would prefer not to use estrogen, estrogen alternatives for bladder irritation may be more useful to you.

Bladder irritation is one of the common symptoms associated with menopause. However, you may find it hard to complain about urinary (and vaginal) symptoms out of embarrassment. Unfortunately, many doctors will not ask you about them. If you manage to whip up the courage to discuss them, hormone replacement with a combination of synthetic estrogen and progesterone may be the only option that is offered to you.
However, there are estrogen alternatives for bladder irritation that can help with these troublesome symptoms.

Estrogen alternatives for bladder irritation and frequent bladder infections

The vagina and bladder are separated by a few layers of cells so any therapy that relieves menopausal vaginal symptoms (e.g. dryness and soreness) will also improve bladder and urinary symptoms.

1. Soy – this contains isoflavones with mild estrogenic activity. It is high in soy protein and dietary fibre. You need 50-150 mg of isoflavones a day. Eating 2-3 servings of soy a day can be hard work. A very good alternative is eating soy bars or drinking soy shakes which makes this easier.
2. Black cohosh – this is a popular herbal remedy. It has mild estrogenic effects and helps to strengthen the vaginal and bladder lining. Take up to 30 drops of extract 2-3 times a day, ½ teaspoon of tincture twice a day, or one 250 mg tablet or capsule 2-4 times a day. Remifemin is one of the few brands of black cohosh that has been clinically proven to relieve menopause symptoms.
3. Marshmallow root – relieves irritation, helps your immune system fight infection.
4. Saw palmetto – helps relieve dryness and lack of tome in the bladder, helps prevent leaking of urine.
5. Cornsilk – helps reduce pain associated with irritation and increases urine flow.
6. Motherwort – has a calming effect, relieves pain by relaxing tissues and helps cure infections.
7. Garlic helps to cure infections and stimulates the body’s defense systems.
8. Aromatherapy – essential oils which may be beneficial include:
   • juniper
   • cedarwood
   • eucalyptus
9. Supplements – these help to support your system as you use some of these alternatives. They include:
   • Vitamin C
   • Calcium
   • Magnesium
   • L-Glycine
   • L-Carnitine

You can combine many of these remedies to give the best results. Some are sold as part of ‘menopause relief’ or ‘urinary/vaginal support’ formulas. It is important to buy from reputable vendors to avoid using substandard and/or adulterated products.

With a little resourcefulness, you can relieve bladder symptoms and other menopause-related symptoms with these safe alternatives.

What is progesterone and USP natural progesterone?

Progesterone is a steroid hormone produced from cholesterol in the ovaries by the corpus luteum (the tissue that is left behind after ovulation). It is also produced in the adrenal gland in smaller quantities. It is converted in the body to produce other steroid hormones like estrogen, testosterone, cortisol and androstenedione.

The main aim of progesterone in women is to sustain any pregnancy that may arise from fertilization of the egg released from the ovary during ovulation.

Progesterone is manufactured from Diosgenin, a substance found in Mexican Wild Yam and also from soybeans. It is converted to bioidentical progesterone in the laboratory.

USP stands for United States Pharmaceutical grade. This means that the progesterone is extracted under the strictest conditions to ensure that it the same as the progesterone that is produced in your body by the corpus luteum and that it is of the highest quality.

You may see wild yam creams or those with mexican yam extract. These are a total waste of money! They contain only diosgenin which is cheaper than bioidentical progesterone. It cannot be converted to progesterone in the body. It will not improve your symptoms.

What are the side effects of progesterone? Should I expect the same from a natural bioidentical progesterone cream?

The side effects associated with progesterone are usually found with the synthetic progesterones known as progestins. Manufacturers take the bioidentical progesterone produced from plant sources and change the structure to achieve various results e.g. give it longer lasting effects. The body recognizes these substances as foreign and so reacts to them in various ways leading to side effects.

The use of synthetic progesterone and congestion symptoms are quite common. The usual side effects are:

• storing of excessive salt in the body. This leads to fluid retention which causes symptoms of congestion such as painful breasts, generalized bloating and weight gain
• depression and mood swings
• migraine headaches
• inability to sleep properly
• loss of sex drive
• heart problems
• kidney problems
• low blood sugar levels
• acne
• skin rashes
• premenstrual discomfort
• hair loss
• excessive hair growth

On the other hand use of bioidentical natural progesterone has virtually no side effects. At the most, using too much causes drowsiness which is easily reversed by decreasing the dose.

What should I expect when I start using natural progesterone cream?- What are the side effects of bioidentical progesterone?

If your body has very low levels of progesterone, the body tunes down your estrogen receptors making them less sensitive to the estrogen in the body. This is to avoid the negative effects of excess estrogen. When you start using progesterone cream, the body “tunes up” your estrogen receptors. You may start to notice some symptoms of estrogen excess. These include:

• Water retention (making you feel bloated)
• Painful, swollen breasts
• Headache
• Temporary increase in the thickness of the lining of your uterus

Don’t be discouraged. Most of these symptoms disappear within 2 or 3 months. To get the most out of your progesterone cream, follow the instructions closely and be consistent. Watch your symptoms. As they lessen, you may try to reduce the dose of cream you apply. This way you can try and find the minimum amount your body needs.

If you feel sleepy all the time, you may be experiencing symptoms of high progesterone. You may need to reduce the dose. If your symptoms aren’t improving you may not be getting enough progesterone and may need to increase the dose.

When you’re gettiing started, allergic reactions to the progesterone cream may occur. After the first few applications or if you have recently changed your brand of cream, watch out for side effects which may not be directly related to the progesterone. They may occur if you are using a poor quality cream which may be high in impurities and oils that can cause allergic reactions.

The signs of allergy may range from mild

• redenning/peeling of the skin
• rashes and
• itching, to severe
• dizziness
• palpitations.

Stop using the cream immediately and see your healthcare provider.

Be sure to buy a good quality cream from a reputable vendor.

Cream progesterone vs oral – which is better?

Progesterone cream can be applied to the skin to relieve many symptoms associated with menopause. It is absorbed into the fat under the skin from where it goes straight into the blood stream from where it circulates to the rest of the body to carry out its effects.

Relatively small doses such as those found in over-the-counter, non-prescription, bio identical progesterone creams can still be effective in relieving menopause symptoms.

When progesterone is taken by mouth, like everything else you swallow, it is absorbed into the blood and taken to the liver. Here more than 3/4 of it is removed and converted to an inactive form leaving only a small amount of progesterone to act in the body. This means that much larger doses are required to achieve the same effect as what you get from applying it to the skin.

Using USP natural progesterone cream is preferable. It allows you to get a dose of progesterone that is close to what your body would be making naturally before menopause. Also, side effects from progesterone cream are minimal, at the most you will experience drowsiness if you use too much.

I have light pink spotting after use of progesterone suppositories – what’s wrong?

Progesterone suppositories supplement any progesterone in your body bringing levels back to normal. It normalizes the endometrium (lining of the womb) by causing shedding of the excess layers that are built up by unbalanced estrogen.

This shedding appears as spotting or what is known as breakthrough bleeding which may resemble a light period. Many women experience this as a side-effect of progesterone suppositories.

There is no cause for alarm. The spotting usually subsides within 2-3 cycles.

Does progesterone cause ovarian cysts?
Progesterone does not cause ovarian cysts. It helps them to resolve (shrink) by normalizing hormonal imbalance which can cause ovarian cysts.

Can progesterone cause hair loss?

Hair loss is a common symptom associated with the post-menopausal years. It comes in various forms:

1. hair becomes thinner and lighter coupled with difficulty in styling,
2. alopecia where the hair actually comes out from the roots leaving bald patches and
3. male pattern baldness where hair is lost at the temples and the crown of the head.

The low estrogen levels associated with menopause cause weakening of the connective tissues from breakdown of the collagen, protein and elastic fibers in it. These are what gives your skin, hair and nails their strength and suppleness.

Can progesterone cause hair loss if used to treat menopause symptoms? On the contrary, progesterone helps to your body’s normal hair pattern. It helps to normalize zinc and copper levels which are essential for healthy hair.

Guidelines for using natural progesterone cream

You can use natural progesterone cream to manage a number of problems that are related to hormonal imbalance.

• General guidelines for using natural progesterone
• PMS
• Hysterectomy
• Premenopausal women
• Fibrocystic breast disease
• Endometriosis
• Menstrual migraine headaches

How to apply natural progesterone cream

• Spread the cream thinly over a large area of skin for maximum absorption.
• Make sure skin is clean and clear of cosmetics. Do not apply other skin creams in the same area on the same day.
• Apply to areas like the breasts, chest, inner thighs, buttocks and neck where skin is thinnest.
• Don’t be concerned about getting the exact amount of cream correct. The progesterone is absorbed continuously from the skin.
• If you are using a large dose, split it. Use 1/3 of the dose in the morning and 2/3 at bedtime. The higher dose is especially useful if you have trouble sleeping at night.
• Buy good quality bioidentical progesterone cream from a reputable vendor. You have to be careful for the following reason
  1. the cream will not be effective if it is not suspended in the right medium
  2. creams containing mineral oil will not be absorbed properly
  3. the progesterone in some creams is not properly stabilized so it breaks down fast, making the cream useless
  4. some products containing wild yam extract don’t contain any progesterone
  5. some creams contain other chemicals that may cause allergic reactions and rashes

Dosage guidelines for bioidentical progesterone cream

PMS

Start counting with the first day of your period as day 1. Starting on day 12, apply 1/2 teaspoon of cream morning and night until day 26. If your period starts before day 26, stop using the cream. Once you see your period, start counting day 1 again, then start the cream on day 12. This dose should help relieve your symptoms much faster. When they are less severe, you can reduce the dose to 1/4 teaspoon twice a day.

Hysterectomy

Whether your ovaries have been removed or not, choose a day of the month (the 1st day is easiest to remember) and count it as day 1. Start applying the cream on that day,1/4 teaspoon morning and night until day 25 when you stop. From day 25 to the end of the month do not apply any cream. Start again on the 1st day of the new month. If you have just had a hysterectomy, you may double the dose to 1/2 teaspoon twice a day for the first month if your symptoms are very severe.
If you experience severe hot flashes and vaginal dryness, you may wish to use a combined estrogen/progesterone cream.

Premenopausal women

Whether you are menstruating regularly or irregularly, use 1/4 teaspoon bioidentical progesterone cream twice daily starting from day 12 (the 1st day of your period is day 1). Stop applying the cream on day 26. When you see your period start counting again until day 12 then start applying the cream again.
If you have irregular periods, it may take up to 3 months for them to become regular.

Fibrocystic breast disease

Use 1/4 teaspoon of cream twice daily from the middle of your cycle till you have your period, then stop, repeat again from midcycle. After 3 to 4 months, symptoms should have improved so the dose can be reduced.

Endometriosis

Use 1/4 teaspoon daily starting from day 8 to the end of your cycle. Once symptoms are reduced you can start applying the cream from day 12 until your period starts.

Menstrual migraine headaches

Use the cream for the 10 days before you expect your period e.g. if you have a 30 day cycle, start on day 20, a 26 day cycle, start on day 16 etc. Use 1/4 teaspoon twice daily.
When you get the familiar feeling or aura that comes before your migraine, apply 1/4 to 1/2 teaspoon of cream every 3-4 hours until symptoms have subsided. Applying the cream directly to the neck or temples may bring faster relief for hormonal headaches.