After menopause the tissues in the vagina, urethra and bladder can lose their tone and elasticity. This makes it harder to hold your urine and can lead to stress incontinence and urge incontinence. Oral hormone replacement therapy does not reach these tissues and so it may be recommended that you apply intravaginal estrogen. Estrogen administered vaginally works locally to improve the health of the tissues with few side effects. Estrogen can be inserted in the vagina via cream, tablet or ring.
Antimuscarinic medications like Detrol (tolterodine) and Ditropan (oxubutynin) are used mainly for the treatment of urge incontinence and overactive bladder. These medications can reduce the irritability of the bladder muscle allowing you to hold more urine for longer periods of time. This category of medication is known for causing dry mouth and constipation.
Mirabegron is a beta-3 adrenergic agonist indicated for the treatment of overactive bladder (OAB) and the symptoms of urge urinary incontinence, urgency, and urinary frequency. This medication works by relaxing the muscles of the bladder.
Antidepressants like imipramine can be used for stress incontinence as they can cause the muscles at the bladder neck to contract. However, they are not considered to be very effective.