Many women complain of urine leakage with activity (stress incontinence) or with an uncontrollable urge (urge incontinence).

Some women feel there is a worsening of the urinary incontinence around the time of the menses. Still others notice a worsening of incontinence symptoms with menopause, when estrogen levels drop to very low levels.

That estrogen plays a role in these symptoms is pretty certain, but exactly how it affects urinary incontinence is not clearly understood. Estrogen has a enhancing effect on the vaginal and urethral mucosa, and the pelvic floor muscles, rejuvenating the tissues and making them more elastic.

The most noticeable effects of estrogen on urinary tract symptoms occur when it is applied locally. This provides high levels that produce dramatic tissue effects, while limiting blood levels and exposure to other body areas such as uterus or breast.

Studies show an significant improvement in post menopausal women urinary symptoms with vaginal estrogen, but ironically an increase in the symptoms when estrogen is given orally. The latter is consistent with women complaining of a worsening of the incontinence with the profession of their cycle, although it is not known exactly why this seems to occur.

The take home message is that vaginal estrogen can significantly improve urinary incontinence symptoms in post menopausal women.