The natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.

One of the most rewarding aspects of my role as CEO of Pelvital is amplifying the conversation around women’s health, especially on historically stigmatised topics like urinary incontinence (UI) and menopause.

If you suffer from bladder leaks, you’re not alone. Research from 2022 shows more than 60 per cent of US women suffer some form of bladder leaks. It is unacceptable that an issue impacting over half of women has historically been kept quiet and stigmatised.

Women are led to believe that bladder leaks are a natural part of being a mum or growing older. That is not true. Although bladder leaks are common, they are not normal, and women should not accept them as such.

Fortunately, there are effective options for treating leaks and education is the first step in self-advocacy – one of the reasons why I love talking about this topic.

First, let’s talk about the different types of UI. Stress urinary incontinence presents as accidental leakage associated with activities like sneezing, laughing, coughing, or jumping.

Urge incontinence (including overactive bladder) involves the sudden urge to urinate followed by involuntary loss of urine. Mixed incontinence is the combination of stress and urge incontinence. Stress urinary incontinence (SUI) is the most common form and is often caused by weakened pelvic floor muscles.

While one in three mothers report SUI within three months of childbirth, UI prevalence indisputably increases with age: 62 per cent of women in their 40s have UI compared to 68 per cent of women in their 50’s, 72 per cent in their 60s and 83 per cent in their 70s.

But does menopause cause incontinence? Yes and no.

Menopause is defined as the natural event of a woman’s final menstrual cycle. It is associated with reduced functioning of the ovaries due to ageing, resulting in lower levels of oestrogen, progesterone, and testosterone.

While these steep hormonal drops don’t directly cause incontinence, they cause thinning of the tissues in the pelvic floor muscles during perimenopause (the time around menopause when your ovaries gradually stop working).

Combine this thinning with common unresolved pelvic floor weakness or injury (e.g. caused by pregnancy, childbirth, pelvic surgery, falls) and/or with common changes associated with ageing (e.g. lowered fluid intake, lowered activity, constipation) – and urinary incontinence can result.

Stress urinary incontinence is most often caused by weak pelvic floor muscles – and menopause-related changes exacerbate that weakness.

Pelvital on-staff pelvic health doctors of physical therapy Shravya Kovela and Leah Fulker describe how this works in a blog on the menopause / incontinence connection: Weak pelvic floor muscles are unable to contract properly to close the urethral sphincter where urine escapes the body.

When paired with hormonal changes of menopause and the resulting changes in tissue flexibility or elasticity of the vulva, vagina, and urethral sphincter, urinary incontinence will appear or worsen.

Furthermore, discomfort in the vulva and vagina associated with menopause-related vaginal dryness or pain may lead pelvic floor muscles to compensate, worsening urinary incontinence.

Interestingly, menopause and ageing do not equally impact incontinence. Menopause transition has been found to correlate with stress urinary incontinence, whereas increasing age and risk factors such as anxiety, BMI, and new onset diabetes correlate with both stress and urge incontinence. And new onset of SUI is highest in perimenopause as opposed to postmenopause.

But the natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.

Tragically, according to the Study of Women’s Health Across the Nation (SWAN) – a historic study to define menopause transition and “characterise its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women” – fewer than 40 per cent of incontinent women even seek treatment from their healthcare provider.

Women are uncomfortable bringing this topic up with their providers and when they do, too often are dismissed without options.

Menopause gaslighting is occurring to women because historically there has been a significant lack of clinically proven conservative options for women who do not wish to have surgery.

Pelvic floor physical therapy has been the shining light here, but a mere one per cent of physical therapists specialise in the pelvic floor, resulting in significant access gaps.

The continued uptick in virtual pelvic health physical therapy options is a big positive, increasing access and enabling women to fit treatment into their lives. Similarly, evidence-based in-home treatment options allow women flexibility and clinicians the ability to extend their clinic walls and deliver conservative care at scale, with outcomes very similar to surgery.

This conversation is incomplete without mention of economics and gender equity. Not only has research into women’s health been historically massively underfunded, but women bear disproportionate out-of-pocket costs.

Specific to UI, 70 per cent of costs are borne by the woman. And that is also completely unacceptable. I am proud to be part of the growing cohort of femtech companies creating change and step by step moving towards broad access and insurance coverage. Women deserve no less.