Estrogen ineffective in treating urinary incontinence

Eighty-three hypoestrogenic women were evaluated in a randomized, placebo-controlled, doubleblind format. All patients were >45 years of age and living in a community dwelling. They were randomized to a placebo group or conjugated equine estrogens, 0.625, mg and medroxy-progesterone, 10 mg, cyclicly for 3 months. Pretreatment documentation of hypoestrogenic state was confirmed by a plasma estradiol of 30 pg/mL or less and parabasal cells on vaginal smear. The primary outcome variable was the number of incontinent episodes per week, and the secondary outcome variables were quantity of fluid loss, voluntary diurnal and nocturnal micturition frequency, generic and condition-specific, health-related, quality-of-life measurements, and patient satisfaction. The pretreatment estradiol level for the treatment group was 10 ± 9 pg/mL and 8 ± 8 pg/mL for placebo. Postreattment evaluation, 61±42 pg/mL and 10±16 pg/mL, respectively. The parabasal cell count was 28 ± 42% for treatment and 56 ± 43% for placebo. Following therapy, it was 3 ± 17% for the treatment group and 49 ± 43% for the placebo group, documenting appropriate estrogen response. Pretreatment urodynamic study confirmed these patients all had evidence of genuine stress incontinence and/or detrusor instability. Following the 3-month trial, no statistical difference was found in the primary or any of the secondary outcome variables. The authors theorize that long-term effects are unlikely to be substantially different. These reports, from a prospective randomized trial, are in defference to prior subjective patient reporting.