Some cancer treatments lower sex hormone levels in the body. In women, these hormones are oestrogen and progesterone.
Low levels of sex hormones can sometimes cause urinary problems in women, including infections and incontinence.
The importance of oestrogen
Oestrogen helps 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. In one study 1 in 10 women (10%) had problems but the true figure may be higher.
Researchers suggest that some women choose not to tell their doctors or nurses because they are embarrassed. Or women may think it is just something they have to put up with.
Urinary problems can be a very difficult problem to cope with and can have an impact on how you feel about yourself and your quality of life.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) can be taken to control any symptoms due to low hormone levels.
But you can’t take HRT if you are having treatment for breast cancer that aims to stop the body producing sex hormones or block their action. There are other things you can do to help.
The number of women who have had breast cancer and develop urinary tract infections or cystitis is between 5 and 8 out of 100 (5 to 8%). If you have diabetes or a prolapsed bladder your risk of developing these problems is slightly higher.
Symptoms of a urine infection
- a frequent and urgent need to pass urine
- pain or burning when you pass urine (cystitis)
- pain in the tummy (abdomen), 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 sex
- reduce vaginal dryness
Some people think that drinking cranberry juice can help reduce the symptoms of cystitis but research has not confirmed this.
Vaginal dryness can cause irritation in the area of the urethra especially during and after sex. This can increase the risk of infection and pain when passing urine. There are various ways of reducing vaginal dryness, including creams and moisturisers.
Urine leakage (incontinence)
Incontinence is an uncommon symptom of low sex hormone levels. It is much 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 have urine leakage.
Treatments can include:
- pelvic floor exercises
- surgery in some cases
- vaginal oestrogen
Research has found that using a vaginal oestrogen can help to reduce incontinence and the need to pass urine often and urgently. It comes in two forms:
- as a cream
- a tablet (pessary) that you put into the vagina and it gradually dissolves
If you have had a hormone dependent cancer such as breast cancer we don’t yet know how safe it is to use vaginal oestrogens. Your body absorbs some oestrogen from vaginal oestrogens but the amount is very small. Research suggests that using vaginal creams or pessaries doesn’t increase oestrogen levels in the blood enough to stimulate breast cancer. More research is needed to find out how safe these products are to use after breast cancer.
Coping with urine problems
Urinary problems can be difficult to cope with – you might feel embarrassed and find it difficult to talk about incontinence or bladder infections.
It is 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.