Can Estrogen Cream Finally Fix Your Bladder Problems?

You feel the tickle in your throat, and you know what’s coming next: a cough. What you don’t know is if your bladder will respond with a leak. Or maybe you’re about to check out at the grocery when your bladder decides you need a bathroom—right now. Life is hard when you have to pee all the time. But if you’re one of the more than 70 million American women who are in perimenopause, menopause, or post-menopause, estrogen cream may help with these bladder issues. ^{1 2}

Menopausal hormone shifts—especially declining estrogen—can affect the way your bladder and urethra function. ³ Symptoms brought on by estrogen drops are collectively known as genitourinary syndrome of menopause or GSM, a condition that affects anywhere from 27 to 84 percent of postmenopausal women. ⁴

GSM symptoms include vaginal dryness, itching, burning, painful sex, and—yes—changes in urinary urgency, frequency, and even incontinence. ⁵

But there’s hope: Doctors and pelvic floor specialists say applying estrogen cream can help turn the tide on GSM symptoms, including urinary and bladder issues.

About the Experts
Heather Alaniz, PT, DPT, OCS is a physical therapist in the Des Moines University Physical Therapy Clinic who specializes in pelvic floor therapy.

Deborah Hess, MS, MS, is a board-certified urologist and a pelvic surgeon with expertise in urogynecology in Wilmington, North Carolina.

How Estrogen Cream Helps Prevent Urinary Incontinence

Vaginal estrogen cream helps prevent urinary incontinence during the menopause years by supporting tissue health in the entire genitourinary area, including the bladder, urethra, and pelvic floor. It also reduces inflammation and may even increase how much urine your bladder can hold before sending you sprinting to the bathroom.

Like the vagina, your bladder and urethra house estrogen receptors that depend on the hormone to maintain blood flow, tissue thickness, elasticity, and moisture. ⁶ When estrogen dips during perimenopause, those receptors are starved, and GSM symptoms flare.

For many women, urinary urgency, frequency, and incontinence can become a chronic nuisance. Studies show vaginal estrogen cream can help reverse these bladder symptoms. ^{7 8}

“Vaginal estrogen cream provides a local effect on the tissues of and around the urethra, of the vaginal wall, and around the bladder,” explains physical therapist Heather Alaniz, PT.

When applied directly to the area, estrogen cream can help stem perimenopause incontinence in a number of ways:

Supports tissue health

Estrogen keeps vaginal and urethral tissues thick, moist, and elastic. When the hormone declines in perimenopause, these tissues begin to thin and dry, a condition called atrophic vaginitis or atrophic urethritis. ^{9 10}

Vaginal estrogen cream restores tissue health. “We really see a plumping up effect for the vulvar tissue,” Alaniz says. “There’s more redness, more natural vaginal lubrication, and that helps with pelvic floor function, closure of the urethra, and even bladder capacity.”

Prevents leakage

Vaginal estrogen cream can help treat pelvic floor weakness and tightness that contribute to urinary leakage in the perimenopause and menopause years.

But first, it’s important to identify whether you have stress urinary incontinence or urge incontinence. Both forms of incontinence become more common in women as they get older—and vaginal estrogen may help with both, says urogynecologist and pelvic surgeon Deborah Hess, M.D. ¹¹

Stress urinary incontinence

Stress urinary incontinence occurs when a weak pelvic floor or urethral sphincter causes leaks during sneezing, laughing, or jumping. Vaginal estrogen cream helps by restoring strength, elasticity, and moisture to the tissues that support the urethra and pelvic floor.¹²

In a 2023 study, 42% of women who suffered from stress incontinence were dry on a cough stress test after 12 weeks of vaginal estrogen therapy. ¹³

Urge incontinence (overactive bladder)

Overactive bladder (OAB) causes a sudden, intense urge to urinate—even when the bladder isn’t full. “It’s an issue of the muscles and the nerves of the bladder,” explains Hess. Treatment aims to relax the bladder, often by limiting known irritants (like caffeine, citrus, alcohol, and spicy foods), monitoring fluid intake, and exercising to strengthen pelvic floor muscles.

Vaginal estrogen cream can be added to these therapies to help relax the pelvic floor and bladder, Hess says. In one study, 64% of women who developed overactive bladder symptoms after menopause said their symptoms improved after trying local estrogen therapy. ¹⁴

Improves bladder capacity

A strong bladder with thick, healthy tissues can hold more urine before alerting you that it’s time to go. And what hormone plays a role in keeping the urogenital tissues that support the bladder supple and strong? You guessed it—estrogen.

“Estrogen is protective of the bladder and the pelvic floor muscles,” Alaniz says. “If, during menopause, a muscle gets stiffened and short, estrogen cream helps lengthen and contract the muscle.”

Researchers believe estrogen impacts bladder capacity in at least two ways:

• Improving pelvic muscle floor strength and elasticity, which raises bladder control
• Raising the bladder’s sensory threshold (i.e., how much pee it holds before it alerts you that you need to empty it). ¹⁵

Reduces inflammation and balances bacteria

Inflammation can cause a host of issues in the bladder and urogenital region. “Without estrogen [the vagina] lacks moisture and hydration, the permeability of the tissue increases, the pH of the vagina increases, so the microbiome changes,” Hess says. “It becomes a more hospitable environment for bacteria and increases your risk of opportunistic infection, like yeast infections and UTIs.”

A 2020 study found that vaginal estrogen increased levels of healthy Lactobacillus bacteria in the bladder, helping relieve OAB symptoms. ¹⁶

Women who suffer from recurrent UTIs—a strong indicator of irritation and inflammation that’s more common during menopausal stages—also get a reprieve from vaginal estrogen. In a 2022 study, postmenopausal women using vaginal estrogen had fewer inflammatory cells and less urothelial cell shedding—a breakdown of tissues from the bladder and urethra—in their urine. This suggests vaginal estrogen can help prevent UTIs and the frustrating urinary symptoms that they bring. ¹⁷

Reduces frequent urination at night

For women suffering from nocturia, or the need to wake up multiple times at night to pee, vaginal estrogen might offer some welcome relief.

“A lot of women lay down at night, and their overactive bladder symptoms are suddenly very apparent and quite bothersome,” Hess says. “If we can [get vaginal estrogen in there to] relax that tissue, we relax the environment, relax the bladder, and there will be improvement in daytime and nighttime symptoms.”

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Estrogen Cream for Bladder Prolapse

As pelvic floor muscles weaken, the organs they support can sag. As a result, the bladder can prolapse—it drops into the vagina, causing urinary urgency, frequency, or incontinence. ¹⁸ If the urethra prolapses, it often leads to painful urination. ¹⁹

Estrogen can’t lift the bladder or urethra back into place—only surgery can do that, Hess says. But the estrogen cream can improve the surrounding tissue quality.

She notes that women who use estrogen cream before prolapse surgery heal faster and have healthier tissues after the operation. Her experience is backed up by a randomized, double-blind trial which found “significantly better” vaginal tissue quality in women who used vaginal estrogen before prolapse surgery, and fewer vaginal atrophy symptoms—including urinary urge, frequency, and incontinence—in the year after the operation. ²⁰

Estrogen Cream When Symptoms Suggest Interstitial Cystitis

Interstitial cystitis (IC) causes chronic bladder inflammation, leading to pain, urgency, and frequent urination. ²¹ While the connection between IC and estrogen isn’t fully understood, some perimenopausal women experience symptom flare-ups when estrogen levels drop during their menstrual cycle. ²²

Hess warns that many menopausal women diagnosed with IC may actually have genitourinary syndrome of menopause (GSM). “I think a lot of women who come to me with pelvic and bladder pain are actually experiencing GSM. They have pelvic floor dysfunction and they need vaginal estrogen and pelvic floor physical therapy,” she says.

How to Apply Estrogen Cream for Bladder Health

The bladder is separated from the vagina by a layer of pelvic floor tissue, so estrogen cream must be placed inside the vagina—not just on the vulva—to reach bladder-supporting estrogen receptors. ²³

Estrogen cream typically comes in a tube and may or may not have an applicator.

If using an applicator:

• Fill it to the indicated dose level
• Insert the applicator into the vagina
• Press the plunger to insert the cream into your vagina

If using your fingers:

• Wash your hands
• Squeeze a pea-sized amount of vaginal estrogen cream onto your index finger
• Insert your finger deeply into your vagina where it can impact all the surrounding tissues and eventually reach the urogenital estrogen receptors, including those at the base of the bladder.
  

When starting vaginal estrogen cream for your bladder or other GSM issues, your doctor may tell you to use it nightly for two weeks then reduce it to 2 to 3 times per week as maintenance.

Estrogen suppositories and rings for bladder issues

Estrogen suppositories, which are pills inserted into the vagina with an applicator, work equally as well as the cream for bladder issues. ²⁴

Another effective option: the vaginal estrogen ring. It looks a lot like a contraceptive diaphragm. Once you insert it into your vagina, it will slowly release estrogen for 3 months. Then you’ll remove it and replace it. ²⁵

How Long Does It Take for Vaginal Estrogen to Treat Bladder Issues?

Women may start to notice improvements in GSM symptoms, including bladder-related issues, after just two weeks of vaginal estrogen therapy. From there, symptoms should continue to improve, though it could take up to four months to achieve the full effect. ²⁶

Other Treatments For Urinary Incontinence During Menopause

Vaginal estrogen cream helps combat urinary incontinence during menopause, but it may work best in concert with other treatments:

• Medications. Doctors may prescribe tolterodine or oxybutinin to OAB patients to relax bladder muscles. Botox injections are another treatment option.
• Pelvic floor therapy. Pelvic floor therapists teach patients various exercises (like good ol’ Kegels!) that help strengthen pelvic floor muscles, leading to better bladder control.
• Tibial nerve stimulation. This non-surgical treatment for OAB stimulates the tibial nerve (a large nerve that runs from the lower back to the foot) with a small needle, sending impulses to spinal nerves to block signals that lead to bladder spasms. ²⁷
• Surgery. Surgical procedures to address stress urinary incontinence include tension-free vaginal tape, retropubic colposuspension (suturing a part of the vaginal wall, the neck of the bladder, and the urethra to the bones and ligaments in your pelvis), slings, and urethral bulking injections. ^{28 29}

Tell your doctor about the urinary symptoms you have during perimenopause or menopause so she or he can help determine the treatment.

Most importantly, advocate for yourself. “If you’re getting pushback or not finding the information you want [for menopausal urinary issues], you can always get referred to a pelvic floor specialist or a urogynecologist,” Hess advises.