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Urinary Incontinence -- One More Purported Benefit of Hormone Therapy Disproved

Data from the Women's Health Initiative showed a higher incidence of incontinence among postmenopausal women who received estrogen therapy than among controls.

Postmenopausal hormone therapy, in the form of estrogen with or without progestogen, has been prescribed to improve or prevent stress or urge urinary incontinence. These researchers analyzed data from the Women's Health Initiative on incontinence symptoms at baseline and at 1-year follow-up among more than 25,000 postmenopausal women who were randomized to receive daily conjugated equine estrogen (CEE; 0.625 mg, with or without 2.5-mg medroxyprogesterone acetate [MPA]) or placebo.

Incontinence was defined as having "ever leaked even a very small amount of urine involuntarily." Incontinence during the previous year was reported by 64% of subjects at baseline (although it was quite mild in 75%-80% of these cases); roughly equal numbers reported stress, urge, and mixed types. Among subjects without incontinence at baseline, overall incidence of incontinence was significantly higher at 1 year with CEE/MPA (relative risk, 1.39) and CEE alone (RR, 1.53) than with placebo; differences were significant or nearly significant for all types of incontinence with both therapies. Among subjects with incontinence at baseline, amount and frequency of incontinence at 1 year increased significantly with both CEE/MPA and CEE alone.

Comment: These results suggest that we can add urinary incontinence to the list of conditions for which postmenopausal hormone therapy should not be used for either prevention or treatment. However, an editorialist discusses some biologically plausible reasons why estrogen might help incontinence, and she argues that further studies -- particularly with topical estrogen -- still are warranted.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine March 22, 2005

Citation(s):

Hendrix SL et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005 Feb 23; 293:935-48.

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DuBeau CE. Estrogen treatment for urinary incontinence: Never, now, or in the future? JAMA 2005 Feb 23; 293:998-1001.

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• Medline abstract (Free)