What to know about hormones, birth control, and bladder pain

In this video, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, the founder of the Fosnight Center for Sexual Health and a medical advisor for Aeroflow Urology, emphasizes that hormonal contraception and other exogenous hormones can meaningfully influence bladder symptoms in patients who are sensitive to hormonal fluctuations, but responses vary widely.

She cautions against the common practice of reflexively prescribing oral contraceptives for menstrual-related symptoms without fully evaluating the individual. Although many people tolerate oral contraceptives well, Fosnight notes that they are a significant contributor to hormonally mediated vestibulodynia—a condition involving structural changes at the vestibule that is closely associated with bladder symptoms. Because of this connection, clinicians must weigh potential benefits against risks rather than assuming hormonal suppression is always benign.

Fosnight highlights the importance of tailoring contraceptive choice to symptom patterns. For patients with severe late-luteal phase symptoms, combined hormonal options such as pills, vaginal rings, or patches may be appropriate trials. Levonorgestrel-containing IUDs are another option, as their effects are largely localized to the uterus; most users continue to ovulate, and the device primarily thins the endometrial lining, which can reduce cramps and prostaglandin-driven inflammation. Progestin-only methods, particularly drospirenone (Slynd), are favored for some patients, including those with PMDD.

She also underscores the role of localized hormone therapy. If estrogen withdrawal contributes to vestibular or vaginal irritation, short courses of vaginal estrogen cream can be highly effective, inexpensive, and safe for most individuals under current guidelines. Timing therapy proactively—based on bladder or menstrual diaries—can prevent predictable symptom flares.

Additional individualized strategies may include consideration of testosterone for pelvic floor muscle support and, importantly, collaboration with pelvic floor physical therapists. Overall, Fosnight advocates for nuanced, patient-centered decision-making that respects hormonal complexity and symptom timing rather than one-size-fits-all prescribing.