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Frequent Urination Before Period
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cwu007 posted:
Every month, about a week before my period I need to use the bathroom, A LOT. It's not just frequent urination but the frequent urge to urinate as well. When I need to go, I need to go. My frequency is about once every 15 to 30 minutes. I noticed when I was watching TV, everytime there was a commercial break, I needed to use the bathroom. This seems to happen in several hour intervals. Like for 4 hours I'm frequenting the bathroom a lot. Then for the next few hours everything is normal. Then I'm using the bathroom a lot again. It always happens the week before my period and the first few days. Never any other time. When I was on birth control, none of this happened. I told this to my OBGYN at my appointment last week. The only answer she could give me was the bloating. She did take a urine sample to test for UTI but I doubt I have it because she hasn't gotten back to me. Anyone have any ideas what could be going on? I'm thinking about seeing a urologist but given the fact that it only happens the week before my period, I have a feeling it is more of a gynelogical problem than a urological problem.
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Jane Harrison Hohner, RN, RNP responded:
Dear cwu: It does sound like urge incontinence also known as detrussor instability or "irritable bladder"--and it is a urologic condition. MULTIPLE literature searches at the National Library of Medicine site failed to yield any published studies on isolated premenstrual urge incontinence. I did find the following reference to endometriosis of the bladder which had worsening urinary symptoms around menstruation:

J Urol. 2000 Jun;163(6):1814-7.
Bladder endometriosis: conservative management.

Westney OL, Amundsen CL, McGuire EJ.

Division of Urology, University of Texas Health Science Center-Houston, Houston, Texas, USA.
Abstract

PURPOSE: We evaluate the characteristics of women with bladder endometriosis successfully treated with hormonal therapy.

MATERIALS AND METHODS: The records of 14 patients with a mean age of 48.7 years (range 26 to 71) diagnosed with bladder endometriosis on cystoscopic evaluation were reviewed for presenting complaints, findings and response to therapy.

RESULTS: The most frequent presenting complaints were urgency (78%), frequency (71%), suprapubic pain (43%), urge incontinence (21%) and dyspareunia (21%). Of the patients 86% did not have a history of recurrent urinary tract infections, 6 (42%) had a history of endometriosis, including 3 who were previously treated with hysterectomy/oophorectomy and 8 (57%) were on some form of therapy for estrogen deficiency. In all patients endometrial implants were identified on cystoscopic examination. In 2 patients the endometrioma correlated to lesions on the serosal surface of the bladder during laparoscopic evaluation. Of the patients 13 were treated either with low dose oral contraceptives, decrease or elimination of the estrogen component of the present regimen or addition of progesterone to therapy, and 12 (92%) reported sustained improvement of symptoms at a mean of 18.6 months (range 8 to 24).

CONCLUSIONS: In more than 70% of cases the presenting symptoms of bladder endometriosis are identical to those of interstitial cystitis. Therefore, endometriosis should always be considered in the patient referred for frequency, urgency and pain with no documented infection. Hormonal therapy is reasonable and effective management for bladder endometriosis. This option preserves fertility, making it especially attractive to younger women.

Your GYN's surmise was a reasonable one. Many women retain fluid (plus any craving for salty foods or increased caffeine) premenstrually. Also, historically progesterone was purported to have a diuretic action. The highest levels of progesterone are reached about one week prior to flow. Lastly, was the birth control pill you used before either Yasmin or Yaz? Both of these contain a type of synthetic progesterone which has known diuretic qualities.

Your best bet may be to at least consult with a urologist since there is no overt evidence in the GYN literature for a premenstrual urgency.

Yours,
Jane


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