Skip to main content

Advertisement

Log in

The Role of Oral Contraception on Bladder Symptoms

  • Overactive Bladder (U Lee, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

While the effects of local and systemic estrogen on the pelvic floor have been widely studied in postmenopausal women, little is known about oral contraceptive (OCP) use and the role on bladder symptoms. Estrogen and progesterone have been implicated in both the treatment and etiology of various pelvic floor conditions including overactive bladder, urinary incontinence, recurrent urinary tract infections, and interstitial cystitis/bladder pain syndrome. This article will review the effect of oral contraceptive pills on bladder symptoms.

Recent Findings

Oral contraceptives appear to decrease the risk of stress urinary incontinence (SUI). The effect of OCP on recurrent UTI, OAB/UUI is unclear. Combined oral contraceptives may be implicated in interstitial cystitis/bladder pain syndrome.

Summary

There appears to be a link between changes in estrogen and progesterone levels and lower urinary tract symptoms. While many studies have evaluated the effect of hormones on the genitourinary tract and bladder function in postmenopausal women menopause, further studies are needed to directly examine the role of OCP in the etiology and treatment of various lower urinary tract conditions. Oral contraceptives are manufactured with a variety of synthetic progestins and with varying dosages of estrogen and progestin, which have been demonstrated to alter endogenous hormone production and hormone receptor expression. Further research how these changes may affect bladder function is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hall KS, Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012;86(6):659–65.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Espuna-Pons M, Ros C, Ortega JA, Aliaga F, Perez-Gonzalez A, Palau MJ. Prevalence, incidence, and remission rates of urinary incontinence in women attended in gynecological practice. Neurourol Urodyn. 2016.

  3. Iosif CS, Batra S, Ek A, Astedt B. Estrogen receptors in the human female lower uninary tract. Am J Obstet Gynecol. 1981;141(7):817–20.

    Article  CAS  PubMed  Google Scholar 

  4. Batra SC, Iosif CS. Progesterone receptors in the female lower urinary tract. J Urol. 1987;138(5):1301–4.

    Article  CAS  PubMed  Google Scholar 

  5. • Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003;62(4 Suppl 1):45–51. This is a review of the effect of estrogen on the genitourinary tract.

    Article  PubMed  Google Scholar 

  6. Hextall A, Bidmead J, Cardozo L, Hooper R. The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation. BJOG. 2001;108(11):1193–6.

    CAS  PubMed  Google Scholar 

  7. Bussillo J, Rhen T, Cidlowski JA. Steroid hormone action. In: Strauss JF, Barbieri RL, editors. Yen and Jaffe's reproductive endocrinology. 7th ed. Philadelphia: Elsevier/Saunders; 2014. p. xvi. 942 p.

    Google Scholar 

  8. Fritz MA, Speroff L. Ebrary academic complete subscription collection. Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011. Available from: http://re5qy4sb7x.search.serialssolutions.com/?V=1.0&L=RE5QY4SB7X&S=JCs&C=TC0000445978&T=marc.

    Google Scholar 

  9. • Zimmerman Y, Eijkemans MJ, Coelingh Bennink HJ, Blankenstein MA, Fauser BC. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(1):76–105. This study examines the effect of oral contraceptives on endogenous hormone levels and hormone receptors.

    Article  CAS  PubMed  Google Scholar 

  10. Kinn AC, Lindskog M. Estrogens and phenylpropanolamine in combination for stress urinary incontinence in postmenopausal women. Urology. 1988;32(3):273–80.

    Article  CAS  PubMed  Google Scholar 

  11. Batra S, Andersson KE. Oestrogen-induced changes in muscarinic receptor density and contractile responses in the female rabbit urinary bladder. Acta Physiol Scand. 1989;137(1):135–41.

    Article  CAS  PubMed  Google Scholar 

  12. Elliott RA, Castleden CM, Miodrag A, Kirwan P. The direct effects of diethylstilboestrol and nifedipine on the contractile responses of isolated human and rat detrusor muscles. Eur J Clin Pharmacol. 1992;43(2):149–55.

    Article  CAS  PubMed  Google Scholar 

  13. Long CY, Liu CM, Hsu SC, Chen YH, Wu CH, Tsai EM. A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women. Fertil Steril. 2006;85(1):155–60.

    Article  CAS  PubMed  Google Scholar 

  14. Fantl JA, Wyman JF, Anderson RL, Matt DW, Bump RC. Postmenopausal urinary incontinence: comparison between non-estrogen-supplemented and estrogen-supplemented women. Obstet Gynecol. 1988;71(6 Pt 1):823–8.

    CAS  PubMed  Google Scholar 

  15. Shenfeld OZ, McCammon KA, Blackmore PF, Ratz PH. Rapid effects of estrogen and progesterone on tone and spontaneous rhythmic contractions of the rabbit bladder. Urol Res. 1999;27(5):386–92.

    Article  CAS  PubMed  Google Scholar 

  16. Jackson S, Avery N, Shepherd A. The effect of oestradiol on vaginal collagen in postmenopausal women with stress urinary incontinence. Neurourol Urodyn. 1996;15:327–8.

    Google Scholar 

  17. Raz S, Rodríguez LV. Female urology. Available from: http://proxy.its.virginia.edu/login?url=https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-B9781416023395X50022.

  18. Ildgruben A, Sjoberg I, Hammarstrom ML, Backstrom T. Steroid receptor expression in vaginal epithelium of healthy fertile women and influences of hormonal contraceptive usage. Contraception. 2005;72(5):383–92.

    Article  CAS  PubMed  Google Scholar 

  19. Amso NN, Crow J, Shaw RW. Comparative immunohistochemical study of oestrogen and progesterone receptors in the fallopian tube and uterus at different stages of the menstrual cycle and the menopause. Hum Reprod. 1994;9(6):1027–37.

    Article  CAS  PubMed  Google Scholar 

  20. Kuiper GG, Shughrue PJ, Merchenthaler I, Gustafsson JA. The estrogen receptor beta subtype: a novel mediator of estrogen action in neuroendocrine systems. Front Neuroendocrinol. 1998;19(4):253–86.

    Article  CAS  PubMed  Google Scholar 

  21. Chen GD, Oliver RH, Leung BS, Lin LY, Yeh J. Estrogen receptor alpha and beta expression in the vaginal walls and uterosacral ligaments of premenopausal and postmenopausal women. Fertil Steril. 1999;71(6):1099–102.

    Article  CAS  PubMed  Google Scholar 

  22. Enmark E, Pelto-Huikko M, Grandien K, Lagercrantz S, Lagercrantz J, Fried G, et al. Human estrogen receptor beta-gene structure, chromosomal localization, and expression pattern. J Clin Endocrinol Metab. 1997;82(12):4258–65.

    CAS  PubMed  Google Scholar 

  23. Eva LJ, MacLean AB, Reid WM, Rolfe KJ, Perrett CW. Estrogen receptor expression in vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2003;189(2):458–61.

    Article  CAS  PubMed  Google Scholar 

  24. Mokrzycki ML, Mittal K, Smilen SW, Blechman AN, Porges RF, Demopolous RI. Estrogen and progesterone receptors in the uterosacral ligament. Obstet Gynecol. 1997;90(3):402–4.

    Article  CAS  PubMed  Google Scholar 

  25. Gebhart JB, Rickard DJ, Barrett TJ, Lesnick TG, Webb MJ, Podratz KC, et al. Expression of estrogen receptor isoforms alpha and beta messenger RNA in vaginal tissue of premenopausal and postmenopausal women. Am J Obstet Gynecol. 2001;185(6):1325–30. discussion 30-1

    Article  CAS  PubMed  Google Scholar 

  26. Blakeman PJ, Hilton P, Bulmer JN. Oestrogen and progesterone receptor expression in the female lower urinary tract, with reference to oestrogen status. BJU Int. 2000;86(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  27. Fu X, Rezapour M, Wu X, Li L, Sjogren C, Ulmsten U. Expression of estrogen receptor-alpha and -beta in anterior vaginal walls of genuine stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4):276–81. discussion 81

    Article  CAS  PubMed  Google Scholar 

  28. Hodgins MB, Spike RC, Mackie RM, MacLean AB. An immunohistochemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina. Br J Obstet Gynaecol. 1998;105(2):216–22.

    Article  CAS  PubMed  Google Scholar 

  29. MacLean AB, Nicol LA, Hodgins MB. Immunohistochemical localization of estrogen receptors in the vulva and vagina. J Reprod Med. 1990;35(11):1015–6.

    CAS  PubMed  Google Scholar 

  30. Pelletier G, El-Alfy M. Immunocytochemical localization of estrogen receptors alpha and beta in the human reproductive organs. J Clin Endocrinol Metab. 2000;85(12):4835–40.

    CAS  PubMed  Google Scholar 

  31. Wolf H, Wandt H, Jonat W. Immunohistochemical evidence of estrogen and progesterone receptors in the female lower urinary tract and comparison with the vagina. Gynecol Obstet Investig. 1991;32(4):227–31.

    Article  CAS  Google Scholar 

  32. Blakeman P, Hilton P, Bulmer J. Mapping oestrogen and progesterone receptors throughout the female urinary tract. Neurourol Urodyn. 1996;15:324–5.

    Google Scholar 

  33. Johannesson U, Sahlin L, Masironi B, Rylander E, Bohm-Starke N. Steroid receptor expression in the vulvar vestibular mucosa—effects of oral contraceptives and menstrual cycle. Contraception. 2007;76(4):319–25.

    Article  CAS  PubMed  Google Scholar 

  34. O'Halloran T, Bell RJ, Robinson PJ, Davis SR. Urinary incontinence in young nulligravid women: a cross-sectional analysis. Ann Intern Med. 2012;157(2):87–93.

    Article  PubMed  Google Scholar 

  35. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.

    Article  PubMed  Google Scholar 

  36. Sultana CJ, Walters MD. Estrogen and urinary incontinence in women. Maturitas. 1994;20(2–3):129–38.

    Article  CAS  PubMed  Google Scholar 

  37. Iliadou A, Milsom I, Pedersen NL, Altman D. Risk of urinary incontinence symptoms in oral contraceptive users: a national cohort study from the Swedish Twin Register. Fertil Steril. 2009;92(2):428–33.

    Article  PubMed  Google Scholar 

  38. Aikawa K, Sugino T, Matsumoto S, Chichester P, Whitbeck C, Levin RM. The effect of ovariectomy and estradiol on rabbit bladder smooth muscle contraction and morphology. J Urol. 2003;170(2 Pt 1):634–7.

    Article  CAS  PubMed  Google Scholar 

  39. Etiz Sayharman S, Tosun N, Aka N, Kose G, Tekin A, Goren Z. Effects of combined estrogen and progesterone replacement treatment on detrusor contractility and histology in oophorectomized rats. J Obstet Gynaecol Res. 2011;37(11):1638–44.

    Article  PubMed  Google Scholar 

  40. Cardozo L, Lose G, McClish D, Versi E. A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder. Acta Obstet Gynecol Scand. 2004;83(10):892–7.

    Article  PubMed  Google Scholar 

  41. Moehrer B, Hextall A, Jackson S. Oestrogens for urinary incontinence in women. Cochrane Database Syst Rev. 2003(2):Cd001405.

  42. Townsend MK, Curhan GC, Resnick NM, Grodstein F. Oral contraceptive use and incident urinary incontinence in premenopausal women. J Urol. 2009;181(5):2170–5.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Taekema-Roelvink ME, Swart PJ, Kuipers ME, Krauwinkel WJ, Visser N, Smulders RA. Pharmacokinetic interaction of solifenacin with an oral contraceptive containing ethinyl estradiol and levonorgestrel in healthy women: a double-blind, placebo-controlled study. Clin Ther. 2005;27(9):1403–10.

    Article  CAS  PubMed  Google Scholar 

  44. Hextall A, Cardozo L. The role of estrogen supplementation in lower urinary tract dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(4):258–61.

    Article  CAS  PubMed  Google Scholar 

  45. Maloney C. Estrogen & recurrent UTI in postmenopausal women. Am J Nurs. 2002;102(8):44–52.

    Article  PubMed  Google Scholar 

  46. Pinggera GM, Feuchtner G, Frauscher F, Rehder P, Strasser H, Bartsch G, et al. Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives. Eur Urol. 2005;47(2):243–9.

    Article  CAS  PubMed  Google Scholar 

  47. Pang X, Cotreau-Bibbo MM, Sant GR, Theoharides TC. Bladder mast cell expression of high affinity oestrogen receptors in patients with interstitial cystitis. Br J Urol. 1995;75(2):154–61.

    Article  CAS  PubMed  Google Scholar 

  48. Quinn SD, Domoney C. The effects of hormones on urinary incontinence in postmenopausal women. Climacteric. 2009;12(2):106–13.

    Article  CAS  PubMed  Google Scholar 

  49. Gardella B, Porru D, Nappi RE, Dacco MD, Chiesa A, Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction—a case-control study. J Sex Med. 2011;8(6):1726–34.

    Article  PubMed  Google Scholar 

  50. Warren JW, Clauw DJ, Wesselmann U, Langenberg PW, Howard FM, Morozov V. Sexuality and reproductive risk factors for interstitial cystitis/painful bladder syndrome in women. Urology. 2011;77(3):570–5.

    Article  PubMed  Google Scholar 

  51. •• Champaneria R, D'Andrea RM, Latthe PM. Hormonal contraception and pelvic floor function: a systematic review. Int Urogynecol J. 2016;27(5):709–22. This is an excellent recent review of studies that examine the effects of various contraceptive methods on pelvic floor disorders.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tamara Grisales.

Ethics declarations

Conflict of Interest

Drs Wood and Grisales declare they have no conflicts of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Overactive Bladder

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wood, L.N., Grisales, T. The Role of Oral Contraception on Bladder Symptoms. Curr Bladder Dysfunct Rep 12, 361–365 (2017). https://doi.org/10.1007/s11884-017-0422-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-017-0422-7

Keywords

Navigation