HRT and Incontinence: Can Hormone Therapy Affect Bladder Control?

Hormone replacement therapy (HRT) is commonly prescribed to help manage menopause symptoms such as hot flushes, night sweats, vaginal dryness and sleep disturbances. For some women, HRT may also help improve urinary and vaginal symptoms linked to falling oestrogen levels during menopause.

However, research suggests that the relationship between HRT and urinary incontinence may be more complex than previously thought.

HRT and Urinary Incontinence

Urinary incontinence is extremely common during and after menopause, affecting millions of women worldwide. Changes in oestrogen levels, pelvic floor weakness, childbirth history and ageing can all contribute to bladder leaks and urgency symptoms.

In the past, HRT was sometimes prescribed to help improve urinary incontinence. However, some studies have suggested that certain forms of systemic HRT may worsen incontinence symptoms in some women.

One large study published in the Journal of the American Medical Association (JAMA) followed more than 27,000 women aged 50–79 as part of the Women’s Health Initiative. Researchers compared women taking oestrogen-only HRT, combined oestrogen and progestin HRT, and placebo treatments.

The study found that some women taking systemic HRT experienced an increased risk of stress urinary incontinence and worsening bladder symptoms compared with women taking placebo treatments.

However, it is important to note that responses to HRT vary between individuals, and local vaginal oestrogen treatments may still be recommended by healthcare professionals for certain urinary and vaginal menopause symptoms.

Supporting Bladder Health During Menopause

If bladder leaks and pelvic floor weakness are your main concerns, pelvic floor rehabilitation is often recommended as a first-line conservative treatment before considering more invasive options.

Strengthening the pelvic floor muscles may help improve bladder support, reduce leaks and support long-term pelvic health during and after menopause.

The Kegel8 Ultra 20 pelvic floor exerciser includes clinically developed pelvic floor exercise programmes, including physiotherapist Amanda Savage’s guided 12-week plan designed to help women strengthen weak pelvic floor muscles safely and effectively from home.

Alongside medical advice, lifestyle changes, bladder training and pelvic floor exercises can all play an important role in managing menopause-related bladder symptoms.

You might also like to see our FREE ebook written by Top UK Physio Amanda Savage all about Menopause and how it affects your Pelvic Floor and what you can do about it.

Sources

[1] https://www.menopausenow.com/articles/the-risks-and-benefits-of-hrt-to-treat-menopause [viewed 06/05/2026]

The Women’s Health Initiative Randomized Trials  concluded Menopausal hormone therapy for 5 to 7 years was not associated with risk of long-term all-cause mortality. [viewed 06/05/2026]

BMS & WHC’s 2020 recommendations on hormone replacement therapy  in menopausal women British Menopause Society  [viewed 06/05/2026]

NICE National Institute for Health and Care Excellence Menopause - Hormone Replacement Therapy HRT Last revised in July 2025  [viewed 06/05/2026]