Efficacy of estrogen supplementation in the treatment of urinary incontinence

J. Andrew Fantl, Richard C. Bump, Deirdre Robinson, Donna K. McClish, Jean F. Wyman, Denise M. Elser, Curt D. Furberg, Samuel F. Lentz, Timothy M. Morgan, Sally A. Shumaker, J. P.James P. Theofrastous

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Abstract

Objective: To assess the efficacy of cyclic postmenopausal hormone replacement in treating urinary incontinence in hypoestrogenic women. Methods: 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, placebo-controlled, 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. Results: (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 measures, or patient's perception of improvement. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)745-749
Number of pages5
JournalObstetrics and gynecology
Volume88
Issue number5
DOIs
StatePublished - Nov 1996

Bibliographical note

Funding Information:
Sponsored by grant UO-I-AG-05170 from the National Institute on Aging and the National Institutes of Health; additional support from the Wyesth-Ayerst and Upjohn companies. *The Continence Program for Women Research Group includes J. Andrew Fantl, from the State University at Stony Brook, Stony Brook, New York; Richard C. Bump, Donna K. McCIish, and Jean F. Wyman, from Virginia Commonwealth University, Richmond, Virginia; Denise M. Elser, from Christ Hospital, Chicago, Illinois; Curt D. Furberg, Samuel F. Lentz, Timothy M. Morgan, Deirdre Robinson, and Sally A. Shumaker, fvom Bowman Gray School of Medicine, Winston-Salem, North Carolina; and Richard C. Bump and James P. Theojrastous, from Duke University, Durham, North Carolina.

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