Hormones May Make Urinary Incontinence Worse

Findings From Large Study Suggest That Oral Hormone Therapy Increases Risk

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Feb. 22, 2005 - A treatment given to postmenopausal women with urinary incontinence actually seems to make the problem worse, researchers say.

A new study shows that menopausal hormone therapy increases the risk of developing incontinence in postmenopausal women and increases the symptoms in already-incontinent women.

The report appears in the Feb. 23 issue of The Journal of the American Medical Association.

The findings represent yet another blow to menopausal hormone therapy, once heralded as something of a fountain of youth for postmenopausal women. Until just a few years ago, millions of women took the hormone estrogen or estrogen plus a progestin in belief that hormone therapy could reduce the risk of heart disease and other diseases of aging.

The large study known as the Women's Health Initiative showed otherwise. In the summer of 2002, an association was made between long-term use of menopausal hormone therapy and an increased risk of heart attacks, blood clots, and breast cancer. Today, the therapy is primarily recommended for relief of menopausal symptoms such as hot flashes, and its use is limited to the shortest time possible.

Hormones Cause More Incontinence

It is also still used for the treatment of urinary incontinence in menopausal women, but proof of its effectiveness is lacking.

Urinary incontinence is about twice as common among women as men, with about a third of women over the age of 65 experiencing some type of incontinence.

Stress incontinence occurs with sneezing, coughing, or any other activity that increases pressure on the bladder, while urge incontinence is caused by sudden and involuntary contractions of the bladder muscle. Many women have a combination of both types.

Using data from the Women's Health Initiative, Wayne State University researcher Susan L. Hendrix, DO, and colleagues evaluated the impact of menopausal hormone therapy on urinary incontinence and its severity in postmenopausal women.

Roughly 23,300 study participants were questioned about prior urinary incontinence symptoms when they were enrolled in the trial. They received either menopausal hormone therapy (estrogen alone or in combination with a progestin) or a placebo pill.

After one year, women without incontinence at the start of the study who were given menopausal hormonal therapy had an increased incidence of stress incontinence, urge incontinence, or a mix of the two.

Women with urinary incontinence at the beginning of the study also report a worsening of symptoms more often if they were taking menopausal hormone therapy.

Women taking hormones were also more likely to report that incontinence limited their daily activities.

Incontinence Isn't Inevitable

Hendrix tells WebMD that the findings offer conclusive evidence that hormone therapy is not an appropriate treatment for urinary incontinence.

She also speculates that many women who have taken hormones for stress incontinence have ended up having unnecessary surgery when their symptoms worsened.

"How many women have been told they needed a surgical procedure due to the side effects of this medication that was supposed to be helping?" she asks.

Geriatrician Catherine DuBeau, MD, outlined several concerns about the methods used by Hendrix and colleagues in an editorial accompanying the study. But in an interview with WebMD, DuBeau says the researchers presented a convincing case against the use of oral menopausal hormone therapy for the treatment of urinary incontinence.

She added that the jury is still out on hormonal cream treatments, which have not been studied. And she stressed that there are many other effective treatments for both urge and stress incontinence. They include medications (for urge incontinence), pelvic-strengthening exercises, and behavioral therapy.

"Incontinence is not a normal part of aging, and it is not something that women have to live with," she says. "Women with this problem should definitely talk to their doctor about it because there are highly effective treatments."

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SOURCES: Hendrix, S. The Journal of the American Medical Association, vol 293; pp 935-948. Susan L. Hendrix, DO, department of obstetrics and gynecology, Wayne State University School of Medicine, Detroit. Catherine E. DuBeau, MD, section of geriatrics, University of Chicago.
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