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HRT Increases Risk for Incontinence

The Longer the Hormone Replacement Therapy, the Greater the Risk
WebMD Health News

April 30, 2003 (New Orleans) -- Last summer women found out that hormone replacement therapy -- once thought to be a magic bullet that could protect bones, brain, and heart -- did not live up to its promise. Instead of offering protection, the hormone regimens actually increased risks for heart disease, stroke, blood clots, and breast cancer.

Now there is more bad news from a study of women with heart disease: Women who took hormone replacement therapy were much more likely to develop urinary incontinence than women given dummy pills. And that's not all: The longer women took the hormones, the greater the risk.

So, women who take HRT for four years, which is not unusual among postmenopausal women, "have a five-fold increase in risk while women taking it for a year double the risk" for incontinence, says Jody Steinauer, MD, a research fellow at the University of California, San Francisco. Steinauer presented the study results at the 51st Annual Clinical Meeting of the American College of Obstetricians and Gynecologists.

Steinauer and her colleagues collected information about urge incontinence and stress incontinence. Urge incontinence is involuntary leaking that occurs as an accident before one reaches the bathroom. Stress incontinence is involuntary leaking that occurs when coughing, sneezing, or laughing.

She says 48% of the women who took daily hormone replacement therapy developed urge incontinence while 54% developed stress incontinence. Of those taking placebo pills, 36% developed urge incontinence and 38% developed stress incontinence.

The results are based on information collected from 1,228 women who had no symptoms of either stress or urge urinary incontinence when the four-year study started.

All of the women in the study had a history of heart disease and their average age was 66. The researchers tracked incontinence using patient questionnaires. Half of the women were on daily HRT and half took a placebo.

Steinauer tells WebMD she is not sure why estrogen increases the risk for incontinence but she noted that estrogen does make tissue "more supple and it may be that making it more supple may also make it more relaxed, which decreases bladder control."

At one time researchers thought that estrogen could "be used to treat incontinence. This is understandable since there is such a wide network of estrogen receptors in the bladder and throughout the urinary tract. But earlier treatment studies reported no advantage," she says.

Gerald Joseph, MD, medical director of women's services, St. John's Health System, Springfield, Missouri, tells WebMD he is not surprised by this finding. He noted that many surgeons direct women undergoing pelvic reconstructive surgery to use estrogen to promote healing but he said that he has never seen any clinical evidence of a benefit.

Isaac Schiff, MD, chief of Vincent Memorial Hospital Obstetrics and Gynecology Service, Boston, a nationally recognized specialist on hormone therapy, tells WebMD these latest data should be considered in the context of the entire estrogen picture. "The final sentence has not yet been written." He says, for example, there "is some suggestion that estrogen may be useful for treating women with recurrent urinary tract infections."

Steinauer takes a similar approach. She tells WebMD that despite the study results, she still prescribes estrogen for women who have "debilitating hot flashes. Hands down, estrogen is still the best treatment for those symptoms."

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