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IC, Hormones, Perimenopause
that hormonal changes affect systemic conditions with flare-ups and
remissions such as IC, fibromyalgia (FMS), chronic fatigue syndrome
(CFS), vulvodynia, multiple chemical sensitivity (MCS), irritable
bowel syndrome (IBS), Sjogren's syndrome and lupus.
has been speculated as a possible cause of IC. Whether IC is, or is
not caused by a hormonal imbalance in some patients, hormones certainly
affect IC symptoms during the monthly menstrual cycle, during pregnancy,
and during perimenopause and menopause. Understanding how hormones
affect the bladder is very important.
The first day
of the menstrual period is also day one of the menstrual cycle. Although
both estrogen and progesterone are at their lowest levels on day one,
estrogen begins to rise and continues to rise after menstruation.
The rise in estrogen levels thickens the uterus in preparation for
fertilization. The rise in estrogen also thickens the bladder lining
during this time. Estrogen levels reach their peak at ovulation, about
day 14 of the cycle.
During the first
two weeks of the menstrual cycle only a small amount of progesterone
is present. However, after the egg is released during ovulation, estrogen
levels quickly decline and progesterone levels begin to rise in preparation
for pregnancy. Although estrogen levels also begin to rise again,
they stay at a lower level than that of the first half of the menstrual
cycle. During this second half of the menstrual cycle estrogen and
progesterone levels reach a peak around the same time, about the third
week of the menstrual cycle. If the egg released during ovulation
has been fertilized the progesterone levels remain high. If the egg
has not been fertilized both estrogen and progesterone production
diminish quickly. The decline of progesterone levels causes shedding
of the endometrium (the uterine lining), which begins a new menstrual
Vary In IC Patients
There is no set
pattern for symptoms in IC patients. There are patients who experience
an increase in swelling, pressure, pain, and frequency when estrogen
levels are highest. This is believed to happen because estrogen increases
mast cell secretion, therefore increasing inflammatory reactions.
There are patients who feel better when their estrogen levels are
high. Experts believe that IC patients may benefit from the increase
in the thickness of the bladder lining and the lack of progesterone
during this time.
Some IC patients
say they feel best and experience less symptoms during their menstrual
period when hormone levels are low. However, other patients experience
bladder pain during their periods, and almost all IC patients complain
of IC symptoms a few days prior to the onset of bleeding. A number
of IC patients also report pain just after a period and/or around
ovulation. Experts may disagree about the effects hormones have on
the IC bladder, but what they consistently agree upon is that the
bladders of IC patients react to the rise and fall of hormone levels.
Syndrome (PMS) and Chronic Conditions
PMS occurs during
the second half of the menstrual cycle when progesterone levels are
at their highest. Common symptoms include fluid retention, irritability,
headaches, backache, and sometimes, abdominal pain. The lower estrogen
levels and high progesterone levels make some IC patients more susceptible
to bladder symptoms, constipation (especially during perimenopause
when bowel activity slows down), abdominal pressure, stiff muscles
and fatigue. Sensitivities to the environment and to certain drugs
may also be intensified during PMS.
If you watch TV
you may have seen an ad for natural hormone replacement with a mother
and her "30 something" daughter. The mother explains how
hormonal changes can begin in a woman's early thirties. The daughter
in the ad may not notice the changes she is going through at such
a young age (yes, thirty is young!), but if she had IC she would more
than likely feel those subtle changes.
begins when a woman's estrogen levels start to decline. Although this
decline usually begins in a woman's late 30's or early 40's, some
women can begin to experience perimenopausal symptoms in their early
30's. The average length of perimenopause is five to ten years, but
it can take longer.
Menopause is believed
to occur between the age of 45 and 55, with the average age at 51.
Menopause can happen quickly or take two to four years (some women
experience hot flashes into their 70's). When a woman has had no menstrual
period for 12 months and blood tests confirm the decline of estrogen,
menopause is considered official. A woman is no longer in perimenopause.
Instead, she is now in postmenopause.
perimenopause vary woman to woman because the approach to menopause
is so individual. Fluctuations of estrogen create hormonal swings
which in turn can cause night sweats, waking episodes, insomnia, hot
flashes, chills, palpitations, lighter, heavier, or irregular periods,
complexion problems, depression, and troubles with memory and concentration.
Women in early
perimenopause can experience night sweats, insomnia, painful PMS,
and constipation. As hormone levels begin to drop, symptoms can change.
Blood tests are used to determine hormone levels.
Changes that Affect the Bladder During Perimenopause
The smooth muscle
in the bladder, urethra and vagina lose tone and strength as estrogen
levels decline. Because the bladder lining, the nerves, blood vessels,
and muscles that govern urinary function are all affected by estrogen,
the decline of estrogen during perimenopause and menopause increases
sensitivity to pain and susceptibility to bladder problems.
When there is
a decrease in blood flow and lubrication, the urethral, bladder and
vaginal tissue become thinner, drier, less resilient, and more susceptible
to inflammation. These various changes also leave the bladder vulnerable
to infection and can cause symptoms such as urgency, frequency, burning,
and sometimes, mild incontinence (IC does not lead to incontinence).
As IC patients
begin to reach menopause their IC symptoms can also change. Patients
who are used to feeling relief upon urination (due to the lack of
blood flow when voiding) may experience some burning in the urethra
instead. Patients in early menopause may begin to notice cramping
in their pelvic floor around ovulation, right before or after their
menstrual periods. Patients with endometrosis, or irritable bowel
syndrome (IBS) may experience more pain from inflammation and built-up
scar tissue as hormones begin to decline. In general, women with injured
muscles and ligaments from surgeries, childbirth or low back problems
may experience compounded weakness and bladder problems. Pressure
on pelvic veins can cause painful varicose veins, pelvic and leg pain.
Perimenopause is a time to keep back muscles strong, use good support
while sitting and avoid lifting heavy objects (a good idea for IC
patients of all ages).
There are standard
blood tests to determine hormone levels and the appropriate dose of
hormone replacement, but finding the right time to begin replacement
and the correct level or type of hormone replacement is often "trial
by error" for patients with IC. * Patients need to work with
gynecologists or naturopaths who specialize in alternative medication
(if using supplements) to regulate hormonal balance, because everything
changes during menopause, including IC.
Doctors may not
be aware that there are IC patients who cannot tolerate estrogen that
is opposed with progesterone, but usually will understand if their
patients explain that progesterone increases symptoms in women with
other conditions, such as migraine headaches. Alternative doctors
or naturopaths who promote natural progesterone believe that natural
progesterone does not provoke the side effects of synthetic progestins.
However, plant progesterones are known to increase urinary frequency
in women without IC.
Both natural progesterone
and progestins produce a similar anti-growth factor in the uterus
like that of the body's own progesterone. Women who take estrogen
without progesterone risk cell build up in the lining of the uterus,
which may lead to endometrial cancer. A woman's doctor must evaluate
health profile, as well as her family history when prescribing hormone
a role in the management of many chronic conditions. The effects of
estrogen seem to fight pain in a variety of conditions. There are
many IC patients who avoid severe bladder, muscle and joint pain and
IBS symptoms with estrogen replacement. However, there are IC patients
who experience bladder pain with estrogen replacement because of the
increase of mast cell secretion. What works depends on the individual
on estrogen is disturbing. Researchers know now that although estrogen
improves some cardio-vascular risk factors, it does not lower stroke
risks. Women who have been diagnosed with heart disease are being
advised to avoid taking estrogen. Also, the fact that breast cancer
is most prevalent in developed nations, where women are treated with
hormone replacement, is not good news for women who use estrogen.
Although I am
not at risk for stroke, heart disease or breast cancer, I have recently
reduced my estrogen dosage. I am now experiencing hot flashes and
waking episodes at night, but my IC symptoms have not worsened. I
plan to continue with the lower dose of estrogen for a few years after
my menopause is considered official. Then I will see where I stand,
and if I need a little estrogen for my bladder I will definitely continue
to use it. I can honestly say that my IC symptoms have really improved
with menopause and they would not have without estrogen replacement.
But as always, IC patients are all different. What helps some makes
information about hormone replacement choices and menopause management
without hormones refer to our
Patient to Patient: Managing IC & Related Conditions book,
now on sale in the ICN Shop!
* The Menopause
Home Test kit has recently been developed.
Women are encouraged to discuss the results of their tests with their
is an author and IC patient & support group leader who has
been involved in IC work for years. In 1990 she published "Stretch
Into a Better Shape" and produced a stretching and exercise
video for IC patients in 1993. She is a specialist in Aston-Patterning
movement and muscle re-education.
over ten years of clinical and health care management position.
He is currently the Administrator of Maison Hospitaliere, located
in New Orleans. Andrew holds a Ph.D. in Special Education, a
M.A. of Health Adminstration, M.A. of Clinical Psychology.
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