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Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age

  • Review Article
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Abstract

Introduction and hypothesis

The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women.

Methods

This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review. This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022. The following key words were used “nocturia” and “menopause” or “nocturnal frequency and menopause.” Moreover, key words including “incidence,” “prevalence,” “insomnia,” “estrogen therapy,” “metabolic syndrome,” and “hot flushes” were used in combination with the aforementioned key words. Last, the reference lists of articles obtained were screened for other relevant literature.

Results

The perimenopause can be a trigger for inducing nocturia. Typically, obesity, body mass index (BMI), and waist circumference are risk factors for developing peri-menopausal nocturia. Presumably the development of peri-menopausal nocturia is multifactorial, with interplay among bladder, sleep, and kidney problems due to estrogen depletion after the menopause. First, impaired stimulation of estrogen receptors in the urogenital region leads to vaginal atrophy and reduced bladder capacity. Moreover, menopause is associated with an increased incidence of overactive bladder syndrome. Second, estrogen deficiency can induce salt and water diuresis through blunted circadian rhythms for the secretion of antidiuretic hormone and the activation of the renin–angiotensin–aldosterone system. Additionally, an increased incidence of sleep disorders, including vasomotor symptoms and obstructive sleep apnea signs, is observed. Oral dryness and a consequent higher fluid intake are common peri-menopausal symptoms. Higher insulin resistance and a higher risk of cardiovascular diseases may provoke nocturia. Given the impact of nocturia on general health and quality of life, bothersome nocturia should be treated. Initially, behavioral therapy should be advised. If these modifications are inadequate, specific treatment should be proposed. Systemic hormone replacement is found to have a beneficial effect on nocturia, without influencing sodium and water clearance in patients with nocturnal polyuria. It is presumed that the improvement in nocturia from hormonal treatment is due to an improvement in sleep disorders.

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Abbreviations

ADH:

Antidiuretic hormone

AT:

Adipose tissue

ANP:

Atrial natriuretic peptide

BMI:

Body mass index

BNP:

Brain natriuretic peptides

BOO:

Bladder outlet obstruction

CKI:

Chronic kidney injury

CVD:

Cardiovascular disease

GFR:

Glomerular filtration rate

GSM:

Genitourinary symptoms of the menopause

HFs:

Hot flashes

HRT:

Hormonal replacement treatment

ICS:

International Continence Society

LUTS:

Lower urinary tract symptom

MetS:

Metabolic syndrome

NP:

Nocturnal polyuria

OAB:

Overactive bladder

OSAS:

Obstructive sleep apnea syndrome

RAAS:

Renin–angiotensin–aldosterone system

UTI:

Urinary tract infection

VMS:

Vasomotor symptoms

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Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Kim Pauwaert, Wendy Bower, Francois Hervé & Karel Everaert

  2. Department of Human Structure and Repair, Ghent University, Ghent, Belgium

    An-Sofie Goessaert

  3. Department of Urogynecology, King’s College Hospital, London, UK

    Dudley Robinson & Linda Cardozo

  4. Department of Aged Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia

    Wendy Bower

  5. Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium

    Patrick Calders

  6. Department of Physical Therapy, Ghent University Hospital, Ghent, Belgium

    An Mariman

  7. Department of Psychiatry, Ghent University Hospital, Ghent, Belgium

    An Mariman

  8. Bristol Urological Institute, Southmead Hospital, Bristol, UK

    Paul Abrams

  9. Department of Urology, Sant’Andrea Hospital, School of Health Sciences, Sapienza University of Rome, Rome, Italy

    Andrea Tubaro

  10. Department of Urology, Vanderbilt University, Nashville, TN, USA

    Roger Dmochowski

  11. Department of Urology, SUNY Health Science University, Brooklyn, NY, USA

    Jeffrey P. Weiss

  12. Department of Gynecology, Ghent University Hospital, Ghent, Belgium

    Herman Depypere

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  1. Kim Pauwaert
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Kim Pauwaert: literature search, drafting of the manuscript; An-Sofie Goessaert: general discussion, reviewing of the manuscript; Dudley Robinson: general discussion, reviewing of the manuscript; Linda Cardozo: general discussion, reviewing of the manuscript; Wendy Bower: general discussion, reviewing of the manuscript; Patrick Calders: general discussion, reviewing of the manuscript; An Mariman: general discussion, reviewing of the manuscript; Paul Abrams: general discussion, reviewing of the manuscript; Andrea Tubaro: general discussion, reviewing of the manuscript; Roger Dmochowski: general discussion, reviewing of the manuscript; Jeffrey P. Weiss: general discussion, reviewing of the manuscript; Francois Hervé: general discussion, reviewing of the manuscript; Herman Depypere: general discussion, reviewing of the manuscript; Karel Everaert: general discussion, reviewing of the manuscript.

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Correspondence to Kim Pauwaert.

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Conflicts of interest

Dudley Robinson is a speaker for Allergan. Paul Abrams reports being a consultant for Astellas, Teva, and Sandoz. In addition, he is a Speaker for Astellas, Cipla, Ferring, and Sun Pharma. Francois Hervé reports grants from Astellas, Ferring, Apogepha, Coloplast, and Medtronic, outside the submitted work. Karel Everaert reports grants to the institution from Ferring, Astellas, and Medtronic. All the other authors report no conflicts of interest.

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Pauwaert, K., Goessaert, AS., Robinson, D. et al. Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age. Int Urogynecol J 35, 935–946 (2024). https://doi.org/10.1007/s00192-024-05743-1

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