Urinary incontinence is particularl...

Urinary incontinence is particularly prevalent in postmenopausal women Although estrogen therapy has many positive general intents on problems of the vagina, urethra, and bladder, the ends of studies of various estrogen preparations have given mixed comes in the treatment of urinary incontinence. Grodstein and colleagues used data from 39436 women participating in the Nurses' Health contemplation to examine the relationship between postmenopausal hormone therapy and urinary incontinence.

Information forward postmenopausal hormone therapy was first included in the Nurses' Health reflection in 1976. Questions concerning incontinence were introduced in 1996 The postmenopausal women in this analysis were 50 to 75 years of age and reported no urinary incontinence. These women were followed for four years to identify the attack of incontinence. In addition to use of hormone therapy, data were abstracted in succession potentially confounding variables such as smoking, hysterectomy status, material part mass index, medication use, and disability. The incontinence experience of more than 25000 women who used hormone therapy was compared with that of 13480 women who reported not using hormone therapy.

Women who used hormone therapy were slightly les likely to idle talk or have diabetes, and reported a younger age at menopause and higher rates of hysterectomy than women who did not use hormone therapy. During the four years of the close attention the annual incidence of incontinence in women 50 to 55 years of age who did not use post-menopausal hormone therapy was 3 percent In similar women who reported rife hormone use, the incidence was 38 percent The incidence of incontinence rose steadily with age and was consistently higher in women receiving hormone therapy.

Overall, the age-adjusted relative risk (RR) of incontinence was 154 in women taking oral estrogen and 168 in women using trans-dermal preparations. The RR were uniform stronger when only severe incontinence was considered (RR = 202 for oral estrogen) The incontinence risk did not appear to be affected by way of the addition of progestins to the estrogen RR of incontinence were significantly lower in women who discontinued using estrogen than in those who continued its use. The risk did not appear to be related to the duration of use yet was negatively cor-related with the time since discontinuation.

The authors deduce that the risk of developing incontinence is increased in postmenopausal women who use hormone therapy. This risk appears to diminish across time if hormone therapy is discontinued.

ANNE D WALLING, MD

Grodstein F et al. Postmenopausal hormone therapy and risk of developing urinary incontinence. Obstet Gynecol February 2004;103:254-60

COPYRIGHT 2004 American Academy of Family Physicians

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