Could Perimenopause Mimic Some IC Symptoms?

[Blacktech]

Dear Dr. Burks,

Two weeks ago, I visited a urologist with symptoms of bladder irritation (urgency, general discomfort). He performed the potassium test, and it was negative. (I tested negative for UTI with my gyno.) He's not ruled out IC and put me on a short list of dietary restrictions (no caffeine, no spicy foods, no alcohol, etc.), as well as a baking soda solution both morning and evening. Less than a week later, around August 17th, my symptoms cleared up -- which happened to be the day after I went on vacation. My symptoms returned on the 26th -- the day after I returned from vacation. I find the timing of this odd. I even had alcohol at my birthday dinner that week, using the "cheat" my urologist gave me (taking the baking soda solution just before the dinner). No symptoms ensued.

Meanwhile, however, I’m having a whole spate of perimenopause symptoms: night sweats, sleep disturbance, vaginal dryness, and memory issues. (I just turned 41 and my mother started having said symptoms at 38.) My gyno just took a blood test at Day 3 of my cycle, and we're awaiting results. We've taken other blood tests that say my hormone levels are fine, which is tremendously frustrating given these complaints. I recently began taking Estroven and that helps the night sweats a lot. I'm also on Vagifem, as I was having a string of apparently hormone-related yeast and strep infections. I fell off the wagon with the Vagifem, but since I saw the urologist I'm on it regularly.

I know that a whole lot of things can mimic IC. Especially since I tested negative with the potassium fluid and I have all these other symptoms, can bladder irritation simply be hormonal? Or, let's say it is IC: I'm told that IC is not stress related, but could it be stress triggered? (One day back at work/home/daily life and I'm having symptoms. Is this suspicious?)  I am otherwise in spectacular health. I exercise and eat well.

Thank you for whatever insights you can share with me.

B-

[David A Burks, MD]

Unfortuntely, the answer to most of your questions is: we don't know.  You don't fit the definition of IC because you have to have the symptoms for at least 3 months.  IC is a chronic disease and there are a number of things that can cause short term frequency, urgency and pain (uti, vaginitis, endometriosis, overactive bladder). The discomfort is usually related to bladder filling or emptying, not a "general discomfort". The potasium test cannot tell you whether you have IC or not.  It is true that stress can cause urgency and frequency, related to how the emotional center of our brain is wired into the bladder control area of the brain.  Stress can also make existing bladder symptoms worse.  Your menopausal symptoms are probably a separate problem, but its unclear how hormonal changes affect IC.  The fact that the IC female to male ratio is 9:1 probably implicates a hormonal factor but we just don't understand what it is.  Ironically IC symptoms wax and wane spontaneously, so everyone has good weeks and bad weeks.  Foot swelling is not associated with IC.

If you have  at least 3 months of frequency, urgency and pain, pressure or discomfort related to the bladder, and your urine test is negative for infection, and you don't have a structural problem like bladder or vaginal prolapse, endometriosis or other Gyn  problem, you may have IC.  You need a cystoscopy and hydrodistention by someone who is knowledgable in IC and go from there.  Unfortunately there is no rule that you can't have two unrelated problems in the same area of the body.  You will need a team of a good Urologist and Gynecologist to help you thru this.  Good Luck.

[Blacktech]

Thank you very much, Dr. Burks. I can't tell you how scary the cystoscopy business is, especially since I've only had symptoms (on and off) since the third weekend of July. My urologist mentioned he might do it under general anesthesia, which I'm very unhappy about. I don't take going under lightly. A gyno did an ultrasound back in March that was normal, but my (relatively) new gyno hasn't even seen me. Her nurse is the one who sent me straight to the urologist. I think I'll make another appointment and talk directly to my gyno.

Thanks again!

[Blacktech]

I also had foot swelling just before visiting the urologist. I noticed that someone else had asked if IC could have foot swelling, but they've gotten no response. Thank you!