Association of menopausal status and hormone use with bladder health and lower urinary tract symptoms in US women: Results from the RISE for HEALTH study

Objectives: Most previous studies of genitourinary symptoms associated with menopause focus on comparisons of postmenopausal to premenopausal women and less is known about bladder health during menopause. We evaluated associations of menopause status and hormone use with bladder health and lower urinary tract symptoms (LUTS). Methods: Data were collected from May 2022 to December 2023 from a regionally representative cohort of community-dwelling adult women in the United States. Bladder health and LUTS were measured using validated questionnaires. Analyses included multivariable linear and logistic regression models. Results: Of 3,423 eligible participants, 3,126 responded to menopause and hormone use questions. Of these, 1,226 were premenopausal, 260 perimenopausal, and 1,640 postmenopausal. Premenopausal women reported hormone use more often than perimenopausal or postmenopausal women (38.3% vs. 21.5% and 13.2%). Across multiple bladder health scales (BHS, range 0-100) and bladder function indices (BFI, range 0-100), perimenopause and postmenopause status were associated with worse scores compared with premenopause status. Perimenopausal women were more likely to report urgency UI [OR 2.27, (95% CI: 1.49-3.46)] and other LUTS compared to premenopausal women. Hormone use was associated with worse bladder health in postmenopausal women [postmenopause/hormone -6.0 Overall BHS, (95% CI: -9.8 to -2.2)] and BFI [postmenopause/hormone BFI -4.8, (95% CI: -7.4 to -2.2)]. Conclusions: Promotion of bladder health and LUTS prevention is important as women approach the menopause transition. Hormone use was infrequently reported in perimenopausal and postmenopausal women and was associated with worse bladder health postmenopause.