If you find yourself waking up multiple times during the night to use the bathroom, you’re not alone. These frequent trips to the bathroom after bed have a name, and it’s nocturia. Nocturia, by definition, is when you wake up multiple times during the night due to the need to urinate.1 It’s possible for nocturia to become more frequent during perimenopause and menopause due to hormonal changes in your body,2 and in this post we’ll dive more into how any why.
Understanding the Basics About Nocturia
Nocturia can be categorized in 4 ways: Nocturnal polyuria implies frequent urination during the night; global polyuria suggests frequent urination during both the day and night. Nocturia can also be due to bladder functional storage issues, and certain sleep disorders. Research has shown that hormone volatility can contribute to both nocturnal and global polyuria2, which hints to why menopausal women may be more vulnerable to this frustrating problem.
Hormones aren’t the only factor influencing nocturia. Dr. Alyssa Dweck, Chief Medical Officer at Bonafide, explains, “Nocturia, or nighttime urination, may be caused by factors that could affect any age group, such as infection, hydration status, caffeine intake, or even an anatomic issue.” In other words, while hormonal shifts during menopause can have an impact, a combination of physiological and lifestyle factors come together to intensify symptoms.
Menopause introduces other potential contributors. “Specific to those who are advancing in age,” adds Dr. Dweck, “OAB, also known as overactive bladder, GSM or genitourinary syndrome of menopause, and other medical issues, like cardiovascular disease or diabetes, may be to blame.”
For many women, disrupted sleep becomes an unwelcome reality during the menopausal transition, and nighttime trips to the bathroom only make it harder to get the rest your body needs. While occasional awakenings are not abnormal, consistent interrupted sleep can take a toll on everything, from your mood and memory to your immune function and overall well-being.
Keep reading to learn more about what nocturia is, why it can worsen during menopause, and what nocturia treatments are available to help you reclaim more restful, uninterrupted nights.
Nocturia Causes: Understanding What’s Keeping You Up at Night
Getting up to use the bathroom once in a while at night may seem normal, but it can start to feel much more frequent and disruptive during menopause. That’s because several biological changes are happening during this time that can impact how your bladder works.
It's known that hormonal changes affect bladder function. Estrogen, specifically, plays an important role in supporting the health and function of your urinary tract.3 Estrogen also helps to maintain the strength, elasticity, and thickness of the tissues found in the bladder and urethra.4 During menopause, as estrogen levels decline, the tissues in the bladder and urethra can become thinner, less elastic, and more sensitive, which can contribute to changes in bathroom habits.5
According to Dr. Dweck, “Lower estrogen during menopause can result in changes to the genitourinary tissue, which can lead to a change in urinary habits. Genital tissue becomes delicate, inelastic, and prone to small micro-abrasions, particularly during intimacy. In addition, the vaginal microbiome changes due to lower estrogen levels; where diminished levels of “good bacteria,” known as lactobacilli, may increase the risk of infection and contribute to changes in urinary habits.”
All of these shifts can make the bladder more sensitive, which means even small amounts of urine can potentially trigger the urge to go, especially at night.
Can Menopause Cause Nocturia?
As mentioned, it’s possible for menopause to contribute to nocturia and the number of times you wake up during the night to urinate. While it’s not the sole cause, several compounding menopause symptoms may increase the likelihood of nocturia.
Impact of Menopause Symptoms on Nocturia
Sleep disruptions experienced during menopause might make you more aware of nighttime urges, as deep, uninterrupted sleep usually helps you tune out low-level bodily signals, like a partially full bladder. As sleeplessness persists, it’s possible you’ll become more attuned to other disruptive symptoms, like hot flashes, night sweats, and restlessness in the legs.6 These symptoms can all interfere with your body’s ability to sleep through the night – causing frequent wake ups, as well as making it more difficult to fall back to sleep and stay asleep.
As we age, the bladder can become more sensitive when urine is present; it’s also less able to stretch and hold urine for long periods of time. 7 This reduced capacity, paired with increased sensitivity from hormonal changes discussed earlier, can result in multiple nighttime awakenings and more trips to the restroom.
Changes in How Your Body Manages Fluid During Menopause
Your kidneys, along with your body’s circadian rhythm, play a role in how your body processes and balances water.8 During menopause, changes in hormone signals, like vasopressin, a hormone that helps the body regulate water balance, can alter how much urine is produced at night.9
“Vasopressin is a hormone that causes the constriction of blood vessels, influences blood pressure, and regulates water and electrolyte balance in the body via reabsorption of water through the kidneys,” explains Dr. Dweck. “Vasopressin is in-part modulated by estrogen. As estrogen levels decline during menopause, this has potential to disrupt the body’s fluid regulation and reduce water retention.”
As a result, more urine may be produced at night, making it more likely that you’ll need to wake up to use the bathroom.
Other Contributing Factors to Consider for Nocturia
While hormonal shifts experienced during menopause can impact the onset of nocturia, they’re not the only factor at play. Lifestyle habits, certain medications, and preexisting health conditions can also influence how often you need to wake up to use the bathroom at night.
How Your Diet Affects Nocturia
Certain foods and beverages are also known to irritate your bladder and may worsen nighttime symptoms. Caffeine and alcohol, for instance, can act as diuretics, which increase urine production.10 High-sodium meals can also cause the body to retain fluid during the day and then release it at night, potentially triggering more frequent nighttime urination.11 Staying hydrated is important, but paying attention to what and when you drink can make a difference, along with what you eat.
Medications, Health Conditions and Nocturia
It’s also important to be mindful of the medications you take and their side effects, especially diuretics often prescribed for high blood pressure or heart conditions, as they can increase urine output – if taken too late in the day, they may contribute to nocturia.12 Other prescription medications may have urinary side effects as well, so it’s worth reviewing your medication list with a healthcare provider to see if anything could be contributing to your nocturia.
Nocturia may also be a sign of an underlying health condition that requires specific attention. Urinary tract infections (UTIs), diabetes, and even sleep apnea can all cause disruptions in nighttime urination patterns.13 These conditions can be especially common and go undiagnosed in midlife. Be sure to speak with your healthcare provider if you’ve noticed any changes in your urinary habits or have concerns.
Managing Nocturia During Menopause – Nocturia Treatments
Managing nocturia often involves a mix of lifestyle changes and medical support to address both the hormonal and physical factors behind your symptoms. With the right strategies, it’s possible for you to improve your sleep and overall well-being.
Topical Estrogen Therapy
As mentioned earlier, declining estrogen levels during menopause can thin the tissues of the urinary tract, making them more sensitive and less resilient. Topical estrogen therapy applied directly to the vaginal and urethral area, can help restore tissue strength and elasticity by reducing irritation and improving urinary control.14 This form of hormone therapy stays localized, so it typically involves fewer systemic effects than systemic hormone therapy.15 Always consult your healthcare provider first to see if this type of treatment option is right for you.
Pelvic Floor Exercises
Your pelvic floor muscles support the bladder and help control urination. As these muscles naturally weaken with age, childbirth, or hormonal changes, bladder control can become more challenging over time. Strengthening your pelvic floor muscles through targeted exercises, like Kegels, may improve your ability to hold urine and reduce nighttime frequency.16 Targeted support provided by a physical therapist or certified yoga therapist are other ways that could help you meet your goals faster.
Lifestyle Adjustments
Sometimes, small changes can make a big difference. Cutting back on dietary irritants, such as caffeine and alcohol, especially in the evening, can help reduce bladder stimulation.17 Staying active, managing your weight, and going to the bathroom on a schedule may also help train your bladder to hold more urine for longer periods.18 These adjustments may take time, but they can gradually reduce how often you wake at night.
Why It’s Worth Talking to Your Healthcare Provider About Nocturia
If you’re waking up frequently to urinate, it’s not something you need to simply tolerate. A thorough evaluation by a healthcare provider can help identify whether your symptoms are related to menopause, your lifestyle, or a treatable medical issue. If nocturia is accompanied by symptoms like burning with urination, painful urination, or a sudden increase in frequency, you should promptly speak with your healthcare provider. These may be signs of a urinary tract infection, an overactive bladder, or another underlying condition that may need attention.
A medical professional can help determine whether what you’re experiencing is related to nocturia, another urinary issue, or something else entirely. With the right care and support, restful and uninterrupted sleep is possible.
Resources:
- https://my.clevelandclinic.org/health/diseases/14510-nocturia
- https://www.ncbi.nlm.nih.gov/books/NBK518987/#
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6376984/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6376984/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6376984/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6092036/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1472849/
- https://journals.physiology.org/doi/full/10.1152/ajprenal.00301.2019
- https://pubmed.ncbi.nlm.nih.gov/38436669/#
- https://www.healthline.com/health/urination-excessive-at-night#
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7192000
- https://www.ncbi.nlm.nih.gov/books/NBK518987/
- https://www.ncbi.nlm.nih.gov/books/NBK518987/
- https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-new-guideline-on-genitourinary-syndrome-of-menopause
- https://www.contemporaryobgyn.net/view/intravaginal-estrogen-shows-promise-for-treating-postmenopausal-vaginal-atrophy
- https://www.healthline.com/health/overactive-bladder/pelvic-floor-physical-therapy-overactive-bladder#what-is-it
- https://www.medicalnewstoday.com/articles/low-estrogen-bladder-symptoms
- https://www.medicalnewstoday.com/articles/low-estrogen-bladder-symptoms
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