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Some cancer treatments lower sex hormone levels in the body. The main female sex hormones are oestrogen and progesterone.
Low levels of these sex hormones can sometimes cause urinary problems in women, including infections and incontinence.
The importance of oestrogen
An important function of oestrogen is to help to keep the wall of the urethra elastic and the pelvic floor muscles healthy. The urethra is the tube that takes urine from the bladder to the outside of the body. The pelvic floor muscles surround the lower part of the bladder and urethra.
When the amount of oestrogen in the body falls it can weaken the muscles and make the urethra less elastic. This can lead to incontinence or infection.
How common are urinary problems?
Not everyone who has low levels of sex hormones due to cancer treatment develops urinary problems. Researchers suggest that some people choose not to tell their doctors or nurses because they feel embarrassed. Or they may think it is just something they have to put up with.
Urinary problems can be difficult to cope with. And can have an impact on how you feel about yourself and your quality of life.
Do speak to your doctor or nurse if you are having problems. They are used to talking about these issues and can help you.
Urine infection
Symptoms of a urine infection
- a frequent and urgent need to pass urine
- pain or burning when you pass urine (cystitis)
- pain in your tummy (abdomen), your back or sides
- blood in the urine
- a high temperature, chills and feeling sick
Reducing the risk of urinary infection
- drink plenty of fluids (about 2 litres a day)
- empty your bladder before and after sexual activity
- reduce vaginal dryness
Vaginal dryness can cause irritation in the area of the urethra. This can increase the risk of infection and pain when passing urine. There are various ways of reducing vaginal dryness, including creams and moisturisers.
Leaking urine (incontinence)
Causes
Incontinence is an uncommon symptom of low sex hormone levels. It is more likely that there is another cause, such as a urine infection or swelling caused by friction during sex.
But incontinence can sometimes be due to a combination of factors, including low oestrogen levels. Do tell your specialist nurse or doctor if you are leaking urine.
Treatments
Treatments can include:
- bladder training
- pelvic floor exercises
- medicines
- vaginal oestrogen
Bladder training
Bladder training encourages your bladder to hold larger amounts of urine for longer periods of time. You keep a diary of when you go to the toilet and gradually increase the time between each visit.
Pelvic floor exercises
Carrying out pelvic floor exercises could help to reduce your incontinence. Strengthening and maintaining the pelvic floor muscles might also help with other symptoms, such as pelvic pain and pain during sex.
Medicines
Your doctor might prescribe medication if they are likely to help your symptoms. For example, you might have medicine from a group of drugs called anticholinergics. They help to relax the bladder muscle. And help the bladder to hold more urine before you feel the need to go. Making it easier to pass urine.
Vaginal oestrogen
Research has found that using vaginal oestrogen can help to reduce incontinence and the need to pass urine often and urgently. You can either use:
- a cream
- a gel
- a vaginal ring – a small plastic ring that is placed inside the vagina and releases hormones
- a pessary – a small pellet that you put inside your vagina, where it gradually dissolves
Your body will absorb some oestrogen, but the amounts are small. It is unclear whether vaginal oestrogens pose a risk for those who have had a hormone dependent cancer, like breast cancer. Research suggests that it does not raise the levels of oestrogen in the blood very much. Talk to your doctor to see if this might be an option for you.
What else can help to reduce incontinence?
There are other things you can do that can help. This includes maintaining your weight and reducing the amount of caffeine you have.
Coping with urine problems
Urinary problems can be difficult to cope with. It’s important to tell your doctor or nurse if you are having problems. They will have helped many people with these problems before and can recommend the best treatments for you.
Hormone replacement therapy (HRT)
One way to help control hormonal symptoms is to take hormones to replace the ones your body is no longer producing. Hormone replacement therapy (HRT) 
is an effective treatment for many women. But some treatments for breast cancer aim to either stop the body producing sex hormones, or block their action. If you are having these treatments, you can’t unfortunately take HRT.
Doctors don’t routinely recommend that you take HRT if you have a hormone dependent cancer, such as breast cancer. Even if you have finished treatment there is concern that HRT may increase the risk of cancer coming back. Talk to your specialist if you are finding it difficult to cope with your symptoms. They can explain the risks and benefits of HRT and if this is an option for you.
