Understanding Frequent Urination: Menopause, Perimenopause And Pee

Perimenopause and menopause can bring various unexpected changes. If you're suddenly planning your life around loo stops, waking up at 3 am with that intense urge to urinate, or experiencing those surprise leaks when laughing, we are here to talk about it.

Just because these bladder symptoms are common doesn't mean you're stuck with them forever. Here's a look at what's going on down there and what you can actually do about it.

What Is Menopause And Why Is It Making You Pee All The Time?

Typically, menopause occurs between the ages of 45 and 55, and officially starts when you’ve gone 12 full months without a menstrual cycle.

Before that, there’s a transitional phase called perimenopause, which usually begins in your mid-40s and lasts an average of four to eight years. During this time, hormone levels, especially oestrogen, fluctuate and gradually decline. Most women start to notice menopause symptoms like hot flashes and night sweats during this phase.

And it’s not just your temperature that may be affected. Low oestrogen levels can also impact your bladder and contribute to changes in your pelvic floor muscles. In turn, many women notice they may need the loo a lot more often.

How often is 'frequent urination'?

Typically, peeing six to eight times over 24 hours is considered within the normal range for many people. If you're regularly going more often than is typical for you, you might be experiencing frequent urination, also known as polyuria.

To clear up some confusion, let's quickly define:

• Frequent urination (polyuria): Needing the loo more than usual (generally considered more than 8 times in a 24-hour period, though individual norms vary).

• Overactive bladder (OAB): Sudden, intense urinary urgency, often occurring even if your bladder isn't full.

• Urinary incontinence: Urinary incontinence means accidental leaks. This can be stress urinary incontinence (impacted by sneezing, laughing, coughing), urge incontinence (where you feel the urge strongly and suddenly, often leading to leakage before reaching the toilet ), or a combination (known as mixed incontinence).

• Nocturia: Frequent nighttime urination, meaning you regularly wake up more than once during the night needing to pee.

Everyone’s baseline is a bit different. But if you’re going to the loo “just in case” more often than usual, or you’re getting the urge and not sure if your bladder’s actually full, paying attention to your habits can be helpful.

The 21-second pee rule

This concept gained attention following a 2014 study at the Georgia Institute of Technology. What researchers noticed was that most mammals, despite their different sizes, take roughly 21 seconds to empty their bladders.

For humans, this isn’t an exact science, but it can give you a rough idea of your bladder habits. Simply put, if you're peeing less than 10 seconds, your bladder probably wasn't full; peeing for more than 30 seconds might suggest you could be holding it in too long on a regular basis.

Why Menopause Makes Your Bladder Sensitive

Your pelvic floor (the hammock of muscles that holds up your bladder and bowels) can undergo changes associated with age and declining oestrogen levels.

Hormones: oestrogen

As much as it's important for reproductive health, oestrogen also helps keep the tissues of the bladder, urethra, and pelvic floor healthy and supported. As these levels start to fall in perimenopause, it can lead to what's known as urogenital atrophy (now often termed genitourinary syndrome of menopause), causing tissues around the bladder, urethra, and vagina to become thinner, dryer, and less elastic.

That can mean less control over when you need to pee and more sudden urinary urges that are hard to ignore or hold in.

What changes with menopause?

• Loss of bladder elasticity: When the bladder tissue changes, it may not stretch as well, potentially leading to the 'time to pee' signals more often.

• Changes in pelvic floor muscles: The muscles holding everything in place can lose tone over time, and this can be influenced by factors such as previous pregnancy and childbirth.

• Vaginal changes: Lower oestrogen can affect your vagina's healthy bacteria balance. This may increase your risk of urinary tract infections (UTIs), which can be another reason for your frequent urination.

• Pelvic organ prolapse: Factors such as childbirth might have caused pelvic prolapse earlier in life, which starts showing symptoms as menopause kicks in. It means the muscles and tissues that support the organs in your pelvis (like the bladder, uterus, or rectum) get weak or stretched out, and one or more of them can drop down into the vaginal canal.

Because of these changes, you might also experience:

• Needing to pee more often, including at night

• Feeling like you have to go urgently, even if your bladder isn’t full

• Leaking when you sneeze, cough or laugh

• Getting up to pee more than once in the night, most nights

• Feeling like you haven’t completely emptied your bladder

It’s also worth understanding what else might be contributing to your constant urge to urinate. While menopause is a major player, it’s not always the only one. These culprits may also be in play:

• UTIs or vaginitis: Particularly common if experiencing vaginal dryness.

• Nerve issues or interstitial cystitis: These can affect the bladder signals.

• Constipation: Pressure from a full bowel can contribute to bladder symptoms.

• Certain medications: Diuretics prescribed for other health issues are a common example.

• Diet irritants: Alcohol, caffeine, citrus fruits, and spicy or acidic foods can irritate your bladder in some individuals.

• Weight gain: Extra weight adds pressure to your bladder and pelvic floor.

• Stress and anxiety: These emotions can sometimes exacerbate bladder urgency and frequency.

• Underlying health conditions: Diabetes, thyroid issues, or neurological conditions can present with urinary symptoms.

Lifestyle and Behavioural Options For Frequent Urination

Thankfully, there are exercises and practices you can try to help manage your frequent urination symptoms and feel more comfortable again.

These include:

• Pelvic floor exercises (Kegels): To strengthen your pelvic floor muscles, imagine you're stopping yourself peeing. Squeeze those muscles, hold for a few seconds, then relax. A pelvic floor physiotherapist can ensure you are doing them correctly and help create a personalised plan. Eventually, you should aim to do sets of 10, two or three times a day.

• Bladder retraining: Under medical supervision, you learn to start setting regular times to pee rather than rushing as soon as you feel the urge. Gradually, you will try to stretch out the intervals between voids, aiming to hold your pee in a bit longer each time.

• Dietary adjustments: Certain foods and drinks may irritate your bladder and can trigger frequent urination in susceptible individuals. These can include:

  • Coffee and tea

  • Alcohol

  • Fizzy drinks

  • Citrus fruits and tomatoes

  • Spicy foods

  • Chocolate

• Keeping a food diary can be a helpful way to figure out what might be contributing to your symptoms.

• Staying regular: Constipation puts extra pressure on the bladder. To combat this, eat more fibre (fruit, veg, whole grains), drink adequate amounts of water regularly, and keep moving.

• Managing your weight: As with constipation, extra weight also puts pressure on your bladder, potentially worsening your frequent urinary symptoms like leaks and urgency. Losing even a modest amount of weight (if you are living with overweight or obesity) can make a noticeable difference. Gentle walks, yoga or any enjoyable activity that you can sustain is a great place to start.

Vaginal moisturisers and lubricants: Can help relieve dryness-related irritation, which may contribute to reducing the risk of urinary tract infections and vaginitis. However, you should always speak to your doctor first as they may suggest medication such as vaginal oestrogen which may be more appropriate for you.

When Should You See Your GP About Your Frequent Urination?

If your bladder is stopping you from doing things you love, making you avoid going out or waking you repeatedly at night, it's time to chat with your GP.

They will be able to assess what's going on and may refer you to a urologist or pelvic floor physiotherapist who specialises in these issues.

Medical treatments to chat about with your GP

• Prescription meds: Your GP can discuss medications if appropriate, typically after you have already started lifestyle changes but still need more support. Medication options include antimuscarinics, which work by relaxing the bladder muscle to reduce urgency and frequency. Beta-3 agonists (like mirabegron) are an alternative, especially if you don't tolerate antimuscarinics well. Duloxetine can be considered in some cases for stress incontinence.

• Vaginal oestrogen therapy: This is a form of local or topical hormone replacement therapy (HRT) that specifically targets vaginal dryness and irritation caused by reduced oestrogen levels associated with the genitourinary syndrome of menopause. It comes as a pessary, gel, cream, tablet, or ring that you insert into your vagina. This form of HRT is considered one of the safest forms.

• Botox injections: When injected into the bladder wall, Botox relaxes the muscles. In turn, it can reduce that constant “need to go” feeling associated with overactive bladder, especially if other treatments haven’t worked. However, you’ll likely need top-up injections every few months to maintain the effect.

• Nerve stimulation therapy: Tiny electrical pulses are sent to the nerves that help control your bladder (usually through a device near your ankle (PTNS) or implanted near your tailbone (sacral neuromodulation)). The idea is to modulate nerve signals so that the bladder function improves.

• Surgical options: In cases of pelvic prolapse or bothersome urinary incontinence that hasn’t responded to conservative measures, procedures like sling surgery or bulking agents might be recommended.

Remember, your GP will work with you to find a solution you're comfortable with.

FAQs

Is peeing every two hours normal?

Peeing every two hours can be perfectly normal, especially if you're drinking plenty of fluids throughout the day. However, if this frequency is new for you or causing inconvenience, like abnormal urgency, discomfort, or leaks, it’s worth mentioning to your GP.

How to tell if you have low oestrogen?

Low oestrogen often presents physical and emotional symptoms. These can include irregular periods, weight gain, dry skin/lips, thinning hair, vaginal dryness (which may make sexual intercourse painful), hot flashes and night sweats, mood swings, increased anxiety, or depression, as well as other symptoms.

While tests exist (typically blood tests), diagnosis is often based on symptoms and menstrual history, especially in the perimenopausal age range. Your doctor can use your symptoms, medical history and sometimes blood tests to help assess the situation.

Can you tell menopause from urine?

There’s no definitive urine test to confirm menopause. Your GP will typically rely on your age, symptoms, and the changes in your periods to diagnose menopause or the menopausal transition rather than urine tests.

Final Thoughts

Bladder changes before, during, or after menopause are common, but that doesn’t mean you have to live around the loo or quietly put up with it. Whether it’s urgency, leaks or waking up through the night, there are management techniques you can try and support to lean on.

Looking for tips, tried-and-tested products or simply someone who gets it? Join our private Facebook group, Jude & Friends, where we talk openly about the things no one warned us about, what works, and what doesn't.