CeCe was a fit, energetic woman in her late 50s. She came for a consultation about her bladder pain and spasms, which had become so debilitating that she had to catheterize herself several times a day to urinate. At times, bladder spasms were so painful that she had been hospitalized because she was unable to void at all.
She had been healthy, without any history of bladder problems, until about two months after she started estrogen therapy with Premarin. The estrogen effectively relieved her menopausal symptoms of hot flashes and sleeplessness, but she started developed the new symptoms of increased frequency of urination, sudden urges to void, and a burning pain in the area of her bladder.
She had seen multiple doctors; had been treated with many courses of antibiotics, pain medications, and tranquilizers. She had been told she must be having emotional trouble over her children leaving home and to see a therapist. Meanwhile, nothing seemed to be helping, and CeCe was becoming more distraught. After her consult with me, she had already planned to pursue biofeedback training and acupuncture to help decrease the spasm and pain.
“You know, it sounds silly, but I keep wondering if this problem could have any connection to starting the Premarin,” she said. “Before that, I never had anything like this. I’ve asked all my doctors this question, but they have all said there’s no connection.”
I told her that I had seen problems like this due, not so much due to the drug or hormone, but to the dyes used to color the tablet. I explained that the simple way to test her idea would be to change her to a completely dye-free form of estrogen and see if it made any difference over the next few months. I changed her to the white tablet of FDA-approved bioidentical estradiol that contains none of the dyes that might be irritating to the bladder.
CeCe was excited that I thought she might be onto something. I thought it was certainly worth trying a product without any dye to see what happened. If the dye was an irritant causing these bladder spasms, it could still take several weeks for her to see any difference.
She called me in just a few days and practically yelled over the phone, “It’s gone. I have actually been able to urinate on my own without the catheter. This is amazing.”
Even I was astonished at the rapid response. I have seen some pretty surprising improvements in my 25 years of working with women on these complex hormone problems, but none that turned around this fast. It is now several years later, and she has remained on the dye-free estradiol tablets and has never had any return of these terrible bladder spasms.
I have said many times that women often have good intuitive insights about what may be causing problems. As health professionals, I feel we should be willing to listen, and try a simple change like this and at least see what happens, rather than taking the arrogant stand that the patient couldn’t possibly be right.
Dyes in prescription medications have an important function: they help differentiate medicines and doses. Imagine the confusion if all pills and all dose were white. But many of the dyes are based on a chemical group we call azo-tartrazines. These dyes have metabolic break-down products that are excreted in urine and are a potent trigger for “irritable bladder” leading to incontinence and pain. Some of these chemicals are known carcinogens and also can be very irritating to skin and internal membranes (like the gut and bladder). Some of these dyes have been banned due to these effects.
I suggest if you have bladder pain or spasms, or you have “irritable” bowel, it may be wise to watch for and avoid these types of chemicals in the foods, beverages, and medicines you consume. Many food manufacturers will send you a complete ingredient list of their products if you write to their consumer information office. You can ask your pharmacist or check the “Physicians’ Desk Reference” list for a list of dyes and other inactive ingredients in medicines you may be taking.
Another common irritant for many women is the propylene glycol in various vaginal creams, including some of the estrogen vaginal creams that are used to help treat vaginal itching and burning. When women are suffering from low estrogen and the bladder lining or vaginal tissues are thin and very sensitive, these chemical preservatives may cause burning and irritation.
Use of a vaginal 17-beta estradiol cream in a hypoallergenic base without propylene glycol may also help alleviate these problems. Such creams have to be obtained from compounding pharmacies, since all of the commercial estrogen vaginal cream products have to contain propylene glycol (or similar chemical preservative) to prolong shelf life and prevent bacterial contamination. Later, when topical estradiol therapy has restored the health of the tissue, you may be able to tolerate the less expensive commercial products.
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