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Why you pee all the time with amenorrhea - cause of frequent urination in women

Updated: May 16, 2023

Even when we think we are at peak “health” based on the metrics society puts in front of us (which tend to be how muscular we are, how low our body fat is, how much we exercise, how “clean” we can eat), our body gives signs that in fact things are not hunky dory.


A super obvious sign is a missing period (for those with a uterus and not on hormonal birth control*).


Some less obvious but still very common signs (frequency documented in No Period. Now What?):

  • Feeling cold all the time

  • Constant thoughts about food/eating

  • No vaginal lubrication

  • Emotional dysregulation (anxiety, obsessiveness, anger)

  • Digestive issues (“IBS”, bloating, constipation)

  • Brittle hair/nails

  • Needing to pee (urinate) a lot

Most people know about the first symptoms but are caught by surprise by the last one. How could needing to pee a lot be related to amenorrhea, underfueling, etc?


It is actually a thing, with results from a clinical trial supporting the relationship!


The basic idea is that there are estrogen receptors throughout your urinary tract. This has been well established, with genitourinary issues being common in women after menopause.

When the estrogen (and progesterone) levels sensed by those receptors are low, as is the case in menopause and *also* when one has amenorrhea, the lining of the bladder actually atrophies and thins. This can be true with anovulatory cycles, or those in which hormones do not reach normal levels as well.


Bladder lining gets thinner with low estrogen


This has been demonstrated conclusively in a rabbit model, and similar atrophy and degeneration in the bladder lining was found in samples taken in the clinical trial in humans.


The thinner lining then allows for easier penetration of urine, which seems to initiate the signals for urination at a much lower fullness.


In the clinical study, bladder capacity in the women with amenorrhea was about 160mL (~5oz), with first urges to urinate at only 25mL (~1oz).


After resumption of cycles, bladder capacity was normal at an average of 334mL (~11oz) with first urges to pee at 105mL (~4 oz – FOUR TIMES HIGHER).


Urination parameters:

With HA

After recovery

% increase

Bladder capacity

160 mL = ~5 oz

334 mL = ~11 oz

109%

First urination signal

25 mL = ~1 oz

105 mL = ~4 oz

320%

The discussion of the clinical trial commented on the fact that adipose tissue (fat tissue!) is responsible for making the estradiol that is present during the early follicular phase of our menstrual cycles (or, all the time in someone with amenorrhea).


We have been led to believe that low body fat = healthy, but that does not consider that our fat cells actually participate in hormonal generation (see my recent insta post for more details).


If you want to learn more about the science underlying missing periods / anovulatory cycles / underfueling, go to noperiod.info/HA, or dive right into No Period. Now What?. You can also schedule a chat with me here to discuss your own symptoms and a plan for recovery.


– Nico


*If you are on birth control pills, please be mindful that your monthly bleed is not a natural period and you could very well be masking amenorrhea if you fit the other criteria http://noperiod.info/HA


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