Urinary incontinence is a chronically progredient condition that usually begins around in the early forties of life with urine leakage after coughing or sneezing [stress urinary incontinence (SUI)]. Several years later the patients realize that after the feeling of urge to void they may lose urine when waiting too long [urgency incontinence, (UUI)]. The etiology of UUI is unknown. However, previous studies have shown that these patients with UUI could regain continence by the surgical tensioning and elevation of the vagina and the attached trigone of the bladder and the urethra. That effect was achieved by the surgical replacement of the uterosacral ligaments (USL) by laCESA or laVASA according to the Integral Theory by Petros. An additional suburethral tape led to overall continence rates (CR) in between 56% and 87% of these patients. Multivariate analyses revealed that the CR in patients younger than 60 years were significantly higher CR than in the older patients. The CR after a trans-obturator tape (TOT); however, was independent of the age at surgery. It has been hypothesized that this development of incontinence is caused by declining estrogen levels especially peri- and postmenopausally. All patients were suffering from UUI. The diagnosis and the age at menopause were evaluated in the context of personal interviews. In all patients with UUI, the vagina was elevated and tightened in the longitudinal axis laparoscopically by substituting the USL with polyvinylidene fluoride-structures of defined identical length (laCESA, laVASA). If that did not lead to continence, a suburethral tape (TOT 8/4) was inserted some months later. Between 2010 and 2022, 326 patients with UUI underwent the surgical replacement of the ligaments. After previous SUI they had developed UUI after menopause. Patients who got estrogen or estrogen/gestagen combinations before menopause became incontinent only after they had discontinued their hormonal treatment. In total, between 67% and 87% of the patients became continent after surgery. According to decades of life the CR after tensioning the vagina by laCESA/laVASA were between 46% and 58% in 50-year-old patients decreasing to 16% and 20% in patients older than 70 years. An additional TOT 8/4 led to continence in between 43% and 40% of the still incontinent patients irrespective of the age. In all patients urinary incontinence started premenopausally as SUI and progressed to UUI after menopause. This continuous worsening of UUI during the years after menopause was probably caused by the estrogen deficiency. The USL, the vagina and the trigone of the bladder express estrogen receptors indicating that their physiological function is dependent on estrogen. Declining estrogen levels lead to a hypo-estrogenic loss of elasticity leading to laxity, particularly in the USL the vagina and the adherent trigone of the bladder. The decreasing CR after tensioning of the vagina by laCESA/laVASA with increasing age can be interpreted as a consequence of the loss of elasticity caused by the longer duration of estrogen deficiency especially in the trigone of the bladder. Patients with perimenopausal hormone replacement therapy (HRT) only became incontinent when they stopped HRT. That observation warrants further investigations.