Urinary Incontinence in Perimenopause & Menopause: Causes, Symptoms, and Proven Solutions for Women

Urinary Incontinence in Perimenopause & Menopause: What Every Woman Should Know

Urinary incontinence (UI) — meaning leaking urine involuntarily — is a surprisingly common but often overlooked symptom of perimenopause and menopause. It’s not just “part of getting older” — it’s a symptom linked to hormonal changes and pelvic floor weakening that many women can improve or even resolve with the right support.

How Common Is It?

Women experience urinary incontinence at much higher rates during perimenopause and after menopause due to declining estrogen levels and changes in pelvic tissues and muscles.

• Overall, urinary incontinence affects a significant percentage of women, increasing with age. Depending on the definition and study, between roughly 30% to over 50% of postmenopausal women report incontinence symptoms.

• Some research shows that up to around half of postmenopausal women experience urinary symptoms, including incontinence.

• Large population data suggest that over 60% of adult women in the U.S. report some level of UI, with many experiencing moderate to severe symptoms.

Despite this prevalence, many women don’t seek help because they think leakage is “normal” or just something to live with. The truth? There are effective solutions.

Why It Happens in Perimenopause & Menopause

As estrogen levels decline during perimenopause and menopause:

• The tissues of the bladder and urethra become thinner and less elastic.

• Pelvic floor muscles (which support the bladder and help control urine flow) may weaken over time.

• These changes can lead to stress incontinence (leaking when you cough, sneeze, lift, or exercise) or urge incontinence (a sudden, strong need to go).

Risk factors that make symptoms more likely include pregnancy and childbirth history, aging, weight gain, and chronic conditions like diabetes.

This article does not constitute medical advice, and you should always consult your own provider before starting any medication or weight loss plan. (This article contains affiliate links, which means I may get a small commission at no additional cost to you.)

Solutions that Really Help

1. Kegel Exercises & Pelvic Floor Muscle Training

Pelvic floor muscle strengthening — commonly referred to as Kegel exercises — is often the first and most important step. These exercises help tighten the muscles that support the bladder and urethra.

• Evidence suggests pelvic floor training can significantly reduce leakage episodes and improve control. Some studies report a high probability of significant improvement with consistent pelvic floor training.

• Important tip: many women don’t do them correctly at first. Working with a therapist or using guided training can make them far more effective.

A physical therapist who specializes in the pelvic floor can tailor exercises to your exact needs and teach you proper technique.

2. Pelvic Floor Physical Therapy

Unlike self-directed Kegels, pelvic floor physical therapy uses hands-on techniques, biofeedback, and individualized training to strengthen and coordinate pelvic muscles:

• It’s one of the most recommended conservative treatments for UI.

• Many women find dramatic improvements in bladder control, sometimes where self-exercise alone didn’t help.

3. Medical Devices (e.g., Elitone & Similar Tools)

There are at-home and in-office devices designed to support pelvic floor strengthening:

• Some external devices like Elitone use gentle stimulation to help activate pelvic floor muscles and may improve stress incontinence symptoms for some women, though results vary by individual experience.

• Others, like intravaginal trainers like Perifit or biofeedback tech, help ensure you’re exercising the right muscles.

These devices allow you the privacy to do pelvic strengthening in the comfort of your own home.

4. Supplements & Vaginal Estrogen (When Appropriate)

While not a standalone cure, pelvic health supplements (like collagen support, vitamin D, or phytoestrogen blends) and vaginal estrogen therapy (when medically appropriate) can help support tissue health and comfort — especially for genitourinary tissue thinning. Vaginal supplements such as those by Bonafide can help with restoring vaginal moisture.

• Vaginal estrogen creams or rings prescribed by a clinician can help restore moisture and elasticity in tissues affected by estrogen loss, which may reduce irritation and urgency symptoms.

Always check with your clinician before starting supplements or hormone therapy.

5. Pessaries & In-Office Support Devices

For some women, a pessary — a small, reusable device inserted into the vagina — provides support to the bladder or urethra and can immediately reduce stress incontinence:

• It’s a non-surgical option that can make a real difference, especially when pelvic floor weakness contributes to leakage.

6. Urogynecologic Surgery

When conservative treatments aren’t enough or symptoms are severe, surgical options may be considered:

• Mid-urethral sling surgeries and other procedures have high success rates (often around 80% in carefully selected patients) in eliminating stress incontinence.

• Many procedures are minimally invasive and can dramatically improve quality of life, though, like all surgeries, they carry risks and require a recovery period.

Surgery is a valid option — especially after trying non-surgical treatments — and should be discussed with a urogynecologist or specialist.

Final Thoughts

Urinary incontinence in perimenopause and menopause is common, but it’s not something you just have to live with. Whether it’s exercises, physical therapy, devices like Elitone, supportive supplements, pessaries, or surgery — there are solutions that work for many women.

If incontinence is affecting your life — at work, during workouts, or even just when you laugh — talk to your clinician. You deserve effective care and comfort.

This article does not constitute medical advice, and you should always consult your own provider before starting any medication or weight loss plan. (This article contains affiliate links, which means I may get a small commission at no additional cost to you.)