When you gotta go, you gotta go. But when the call of nature sounds during the night, a phenomenon known as nocturia, it may be a symptom of an overactive bladder (OAB). Other symptoms of OAB include urgency and incontinence. Anybody can be affected by OAB, but it’s often associated with menopause. According to one study, 76 percent of women over age 40 reported getting up to go to the bathroom at least once per night. This can lead to an increased risk for falls, hip fractures, even anxiety or depression.

The menopausal body goes through major hormonal changes, including a drop in estrogen levels. This is a common cause of OAB, says Brian Norouzi, M.D., a board-certified urologist at Providence St. Joseph Hospital in Orange County, California. A lack of estrogen can lead to the thinning of the lining of the urethra (the tube that empties urine from your bladder) and the weakening of the pelvic floor (the group of muscles that supports the urethra and the bladder). It’s no wonder, then, that women feel an increased need to pee during menopause.

Everybody’s menopause experience is different, but sharing those experiences can help make this life stage a little less confusing and distressing. And that goes for midnight bladder wake-up calls! Here’s advice from four women on how to deal with this frustrating aspect of midlife.