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Oestrogen therapy

Many women develop overactive bladders after going through the menopause. The bladder is very sensitive to hormone levels, and this may affect you even if you are using HRT treatments. Using an oestrogen cream or pessary, which is inserted into the vagina, can help replenish the oestrogen levels and improve OAB symptoms.

This type of oestrogen treatment is very safe as only minimal amounts are absorbed into the rest of the body, and it does not have the risks associated with many other types of oestrogen treatments.

Anti-muscarinic tablets

If the above treatments do not work, the doctor may recommend medication. Antimuscarinics (also called anticholinergics) are the most commonly used medicines, and these include: oxybutynin, tolterodine, fesoterodine, trospium chloride, darifenacin, and solifenacin. These also come in different brand names. They work by relaxing the bladder muscle and making it less sensitive, which can increase the bladder capacity. 

These medicines may help you to control your bladder symptoms and may make it easier to do the bladder training described above. Side-effects are not uncommon, but are usually minor and tolerable. The most common are dry mouth, dry eyes, constipation or blurred vision. Some patients find the first drug they try does not suit them, either due to side-effects or because if doesn’t work very well. If this happens, don’t worry: the medicines all have differences, and you may find that if one medicine causes troublesome side-effects a switch to a different one may suit you better.

Mirabegron (Betmiga)

Mirabegron is a newer medication for overactive bladder and works in a different way to the anti-muscarinic tablets described above. It was approved by NICE in 2013. The evidence from clinical trials suggests that Mirabegron may be effective even when patients have not responded well to anti-muscarinic tablets. It has few side effects and is a good choice if anti-muscarinics are not well tolerated e.g. due to dry mouth or constipation.

People with high blood-pressure that isn't controlled with medicines should not use Mirabegron. However, most people with high blood-pressure can take Mirabegron provided they are on effective treatment.

Dementia and medications for OAB

We have long known that some elderly people can become confused while taking some medications. Anti-muscarinics can cause this problem in some people. There has also been some recent evidence that suggests that these tablets might be associated with an increased risk of dementia when used for a long time. Experts currently do not know for certain if anti-muscarinics actually cause dementia and this seems to be a problem mostly for patients who are on lots of medications. These is no concern at all with Mirabegron, as this does not cause confusion and does not increase the risk of dementia.