Hormone therapy increases risk of urinary incontinence

CHICAGO What has been considered a treatment for urinary incontinence--estrogen alone or with progestin--has been found to increase the incidence of incontinence in postmenopausal women, according to a study in the February 23 issue of JAMA.

Menopausal hormone therapy (MHT) consisting of oral estrogen plus progestin or estrogen alone has long been used to treat postmenopausal women and, until recently, was credited with many benefits well beyond the indications for symptomatic relief of hot flashes, night sweats, and vaginal dryness, according to background information in the article. One of the purported benefits of MHT was to improve the symptoms of urinary incontinence (UI), and it has often been prescribed to treat UI.

Susan L. Hendrix, D.O., of the Wayne State University School of Medicine and Hutzel Women's Hospital, Detroit, and colleagues conducted a study to determine the effects of MHT (estrogen and progestin or estrogen alone) on the 1-year incidence and severity of symptoms of stress (incontinence that occurs when involuntary pressure is put on the bladder by coughing or laughing or sneezing or lifting or straining), urge (incontinence that is generally attributable to involuntary contracts of the bladder muscle), and mixed UI (involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing) in healthy postmenopausal women. The researchers analyzed data from the Women's Health Initiative (WHI): multicenter double-blind, placebo-controlled, randomized clinical trials of menopausal hormone therapy in 27,347 postmenopausal women aged 50 to 79 years enrolled between 1993 and 1998. Existence of any UI symptoms was known for 23,296 participants at baseline and 1 year. Women were randomized to receive estrogen alone (conjugated equine estrogen, [CEE]), estrogen plus progestin (CEE plus medroxyprogesterone acetate [MPA]), or placebo.

The WHI trials were designed to evaluate the effects of MHT using es

Contact: Jennifer Day
JAMA and Archives Journals

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