Friday Q&A: urinary infections & incontinence; estrogen use in breast cancer patients; testosterone for women; & pelvic floor dysfunction

You ask the best questions!

It’s Friday Q&A time!

In case you missed this week’s content:

• Check out my newsletter: What Can Our Pelvic Floor Teach us About Motherhood?

• Tune into my podcast episode with NYT opinion writer Jessica Grose about the (impossible!) state of American motherhood.

• Don’t miss my recent Q&As on:

  • New Mammogram Guidelines; Vitamin D; Men Asking for Help; & Preventing Caregiver Burnout

  • Antidepressants; Inattention; Social Anxiety; & “Am I Taking too Many Meds?”

  • Masks; Long COVID; New COVID Treatments; & Waning Immunity

Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

---

The first question today (about urinary incontinence) is for all subscribers. The remaining questions (about estrogen in breast cancer patients; testosterone for women; pelvic floor weakness; & frequent UTIs) are for paid subscribers.

Click here to submit your questions (about anything) for future Q&A posts!

Photo by Annie Spratt on Unsplash

Let’s dive in!

QUESTION #1

I get urinary tract infections and urinary incontinence and have been told the only thing I can do is self-catheterize! I’ve tried Detrol and Myrbetriq but no luck. Would vaginal estrogen help?? I am miserable.

-Beth

Dear Beth,

Medications like Detrol and Myrbetriq are certainly an option for patients with incontinence, but they can have unpleasant side effects and don’t always work. If you were my patient, I would first assess your hormonal status and offer you vaginal estrogen if appropriate. Vaginal estrogen has been shown to improve symptoms of genitourinary syndrome of menopause (GSM) which include vaginal dryness, urinary incontinence, and the increased risk of urinary infections as a result of thin, atrophic vaginal tissue. Vaginal estrogen is typically safe for women within 10 years of their last menstrual period—and even after 10 years, depending on the patient.

Next, I would suggest cutting back on foods and drinks that tend to irritate the bladder—like spicy food, caffeine, and alcohol—and limiting your intake of liquids 3 hours before bedtime.

I would then refer you to a uro-gynecologist (a specialist in female reproductive organs and pelvic anatomy) for a thorough assessment of your pelvic floor anatomy and function. If it we learned that you have weak pelvic muscles, you might benefit from pelvic floor physical therapy to strengthen your deep core.

The upshot? I do have some patients for whom self-catheterization is the only option for their urinary issues, but this recommendation is usually made only after we’ve addressed all mechanical, hormonal, and behavioral factors first.

I hope that helps!

---

If you find this helpful, hit the ❤️ button on this post so more people can discover my writing on Substack! 🙏

---

QUESTION #2

 I’m on long-term treatment for metastatic estrogen+ breast cancer. I’ve always thought vaginal estrogen therapy was contraindicated. But I have significant vaginal atrophy and get frequent symptoms of UTI (not always positive for UTI). What is the best thinking on this issue?

-Judith