Will Hormone Therapy Fix Bladder Leaks?Pills and Vaginal Estrogen Point in Opposite Directions

Leaks often start or worsen around menopause, so it seems logical that replacing estrogen would help. A Cochrane review of 34 trials with nearly 20,000 women found the answer depends on how the estrogen is given.¹

Myth: hormone pills will stop leaks

• In trials of estrogen pills, incontinence got worse on average compared with placebo.¹ Much of that result came from a large trial of women without a uterus taking conjugated estrogens.¹
• Women with a uterus taking estrogen plus a progestogen pills also had worse incontinence.¹
• In one large study, women without leaks who took hormone pills for other reasons were more likely to develop new leaks.¹

If your leaks started or worsened after starting hormone pills, mention it to your prescriber.

What vaginal estrogen may do

Estrogen used in the vagina, such as creams or tablets, may improve incontinence.¹

• About one to two fewer bathroom trips in 24 hours¹
• Less frequency and urgency¹
• Side effects included some spotting, breast tenderness or nausea, with no serious problems reported.¹

The trials didn’t show what happens after treatment stops, and there’s little data on long-term effects.¹ Our guide to vaginal estrogen safety evidence covers how little reaches the bloodstream.

Pelvic floor training first

In one small trial, women were more likely to improve with pelvic floor muscle training than with vaginal estrogen.¹ Training and estrogen can be combined. Our guides to doing Kegels correctly, bladder training and pelvic floor therapy costs explain how.

Questions to ask

1. Could my hormone pills be making my leaks worse?
2. Would vaginal estrogen help my urgency or frequency?
3. Should I start pelvic floor therapy at the same time?

Try: “My bladder leaks got worse after I started hormone pills for hot flashes. Could they be contributing, and would vaginal estrogen or pelvic floor therapy help?”

Laugh, Sneeze, Jump includes an appointment prep sheet. Use it to note when leaks started relative to any hormone changes.