I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health.

In this episode, Dr. Alvarez addresses a topic many women experience but rarely talk about openly: urinary changes after 40. If you’ve found yourself planning your day around the nearest bathroom, waking up multiple times at night to urinate, or avoiding exercise because you’re afraid of leaking, this episode explains why these symptoms are common — but not something women should simply accept as “normal.”  

Dr. Alvarez explains how bladder function is connected to hormones, pelvic floor strength, tissue health, metabolism, and the body’s support systems. During perimenopause and menopause, fluctuating and declining estrogen levels can affect the tissues of the bladder and urethra, contributing to urgency, frequency, nighttime urination, and leakage.  

With clarity and compassion, she breaks down:

• Why urinary symptoms can increase during perimenopause and menopause
• How estrogen supports urinary tract tissue, elasticity, blood flow, and pelvic strength
• Why pelvic floor weakness can contribute to stress incontinence during coughing, laughing, or exercise
• Why urinary symptoms are treatable — and not just an unavoidable part of aging
• Why women who have never had children can still experience bladder changes
• What minimum testing may include:
  • Urinalysis to check for infection, blood, or inflammation
  • Post-void residual measurement to evaluate how well the bladder is emptying
  • Hormonal evaluation, including estradiol
  • Metabolic testing, including blood sugar/glucose levels
• Practical prevention steps:
  • Strengthening the pelvic floor
  • Maintaining a healthy weight
  • Staying hydrated while limiting bladder irritants like caffeine
  • Addressing hormonal health
  • Seeking pelvic floor therapy when needed

This episode is a reminder that urinary symptoms are not a source of shame. They are often the body asking for attention. If you are planning your day around the bathroom, avoiding movement because of leakage, or feeling like your body has changed and no one has explained why, it may be time to seek a real evaluation.

Because common does not always mean normal — and becoming the CEO of your own health starts with listening to your body and asking for answers.

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