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Menopause and Interstitial Cystitis

Interstitial cystitis is a painful condition defined by chronic inflammation of the bladder wall. Many sufferers experience urinary urgency and frequency, even though no infection is present. Other patients may have chronic pain in their lower pelvis or bladder. IC affects approximately 1.2 million Americans --about 90 percent are women. If left untreated, IC can cause scarring or stiffening of the bladder wall which may result in the inability to hold much fluid in the bladder. Hormonal imbalances, allergies and toxic substances in urine have been considered a possible cause of IC, but doctors aren't entirely sure what causes it.

  1. Symptoms of IC and Hormones

    • Most IC patients say their symptoms wax and wane during their menstrual cycle. For many women, symptoms get worse during their periods, while others find relief. A number of patients report increased bladder pain right before or after their period or during ovulation. Gaye and Andrew Sandler of the IC Network say that experts disagree about the effects of hormones on the IC bladder, but they consistently agree that the bladders of IC patients react to the rising and falling of hormone levels.

    Perimenopausal Bladder Symptoms

    • In perimenopause, the period when a woman's estrogen levels begin to decline in her late 30s or early 40s, the muscles in the bladder, urethra and vagina lose strength. For most women, actual menopause begins sometime during the late 40s to early 50s and the the continued decline in estrogen may cause increased sensitivity to pain and other types of bladder problems. Since there is a decrease in lubrication and blood flow, the bladder and vaginal tissues become drier and therefore more prone to inflammation. According to Marcy Holmes, a nurse practitioner with Women-to-Women, about 70 percent of women with IC also have highly activated mast cells, which are associated with a decrease in estrogen. The mast cells release histamines, which can further damage the bladder, Holmes says.

    Hormone Replacement Therapy

    • Standard blood tests can help determine hormone levels, but replacement therapy is controversial. The Sandlers say that estrogen replacement helps many IC patients avoid severe bladder problems, but there are other IC patients whose problems are exacerbated by estrogen use. Estrogen therapy is not recommended for women with heart disease or who are at risk for heart disease, stroke or breast cancer, the Sandlers say.

    Medications

    • Currently, the only FDA approved drug for IC is Elmiron. Elmiron is believed to coat the bladder lining, thereby reducing inflammation. Antidepressants are used by some doctors to block pain. These drugs are believed to work by interfering with nerve activity and reducing psychological stress, which can activate mast cells

    Bladder Treatments and Therapies

    • Inserting drugs such as Heparin and Elmiron directly into the bladder helps some patients. Many IC patients also have underlying pelvic floor dysfunction, a condition in which pelvic floor muscles do not relax enough for easy urination. Pelvic floor therapy from a qualified physical therapist may be helpful.

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