Efficacy of estrogen supplementation in the treatment of urinary incontinence

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 88; no. 5; pp. 745 - 749
• Main Authors: Andrew Fantl, J., Bump, Richard C., Robinson, Deirdre, Mcclish, Donna K., Wyman, Jean F.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-1996; Elsevier Science
• Subjects: Biological and medical sciences; Kidneys; Medical sciences; Nephrology. Urinary tract diseases; Urinary system involvement in other diseases. Miscellaneous; Human; Urinary system disease; Treatment efficiency; Estrogen; Urinary tract disease; Estradiol; Ovarian hormone; Voiding dysfunction; Treatment; Double blind study; Postmenopause; Bladder disease; Sex steroid hormone; Woman; Urinary stress incontinence
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/0029-7844(96)00281-5

To assess the efficacy of cyclic postmenopausal hormone replacement in treating urinary incontinence in hypoestrogenic women.
Eighty-three hypoestrogenic women complaining of urinary incontinence were included. All patients were community-dwelling, age 45 years or older, with involuntary loss of urine occurring at least once a week and urodynamic evidence of genuine stress incontinence and/or detrusor instability. Evaluation consisted of a comprehensive clinical and urodynamic research protocol. The hypoestrogenic entry criterion was a plasma estradiol level of 30 pg/mL or less. Parabasal cells on vaginal smears were also monitored. The primary outcome was the number of incontinent episodes per week, as documented on a standardized urinary diary. Secondary outcomes were the quantity of fluid loss, voluntary diurnal and nocturnal micturition frequency, generic and condition-specific health-related quality of life measurements, and patient satisfaction. A randomized, placebocontrolled, double-blind design was used. Subjects in the treatment group were given conjugated equine estrogens (0.625 mg) and medroxyprogesterone (10 mg) cyclically for 3 months. Controls received placebo tablets.
(All results are presented as mean ± standard deviation.) Subjects were 67 ± 9 years old. The menopause duration was 18 ± 11 years. The duration of incontinence was 9 ± 9 years. Estradiol level at baseline was 9 ± 9 pg/mL, and the parabasal cell count was 42 ± 44%. The number of incontinent episodes at baseline was 13 ± 10 for the treatment group and 16 ± 4 for controls. No significant changes occurred in the number of incontinent episodes after treatment: 10 ± 10 for the treatment group, and 13 ± 14 for the controls (
P = .7). Also, fluid loss was not changed: 176 ± 106 g for the treatment group and 64 ± 88 g for the control group at baseline, and 101 ± 150 and 51 ± 69 g after treatment, respectively (
P = .7). There were no significant differences for either diurnal or nocturnal voluntary micturition, quality of life meassures,or patient's perception of improvement.
Three-month cyclic hormone replacement therapy did not affect either clinical or quality of life variables of incontinent, hypoestrogenic women. Long-term effects are unlikely to be substantially different. The use of estrogen supplementation as preventive or adjuvant therapy was not evaluated in this study.