Oestrogen therapy for urinary incontinence in post-menopausal women
- PMID: 19821277
- DOI: 10.1002/14651858.CD001405.pub2
Oestrogen therapy for urinary incontinence in post-menopausal women
Update in
-
Oestrogen therapy for urinary incontinence in post-menopausal women.Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD001405. doi: 10.1002/14651858.CD001405.pub3. Cochrane Database Syst Rev. 2012. PMID: 23076892 Free PMC article. Review.
Abstract
Background: It is possible that oestrogen deficiency may be an aetiological factor in the development of urinary incontinence in women.
Objectives: To assess the effects of local and systemic oestrogens used for the treatment of urinary incontinence.
Search strategy: We searched the Cochrane Incontinence Group Specialised Register of trials (2 April 2009) and the reference lists of relevant articles.
Selection criteria: Randomised or quasi-randomised controlled trials that included oestrogens in at least one arm, in women with symptomatic or urodynamic diagnoses of stress, urgency or mixed urinary incontinence or other urinary symptoms post-menopause.
Data collection and analysis: Trials were evaluated for methodological quality and appropriateness for inclusion by the review authors. Data were extracted by at least two authors and cross checked. Subgroup analyses were performed grouping participants under local or systemic administration. Where appropriate, meta-analysis was undertaken.
Main results: Thirty- three trials were identified which included 19,313 (1,262 involved in trials of local administration) incontinent women of whom 9417 received oestrogen therapy. Sample sizes ranged from 16 to 16,117. The trials used varying combinations of type of oestrogen, dose, duration of treatment and length of follow up. Outcome data were not reported consistently and were available for only a minority of outcomes.Systemic administration (of oral oestrogens) resulted in worse incontinence than on placebo (RR 1.32, 95% CI 1.17 to 1.48). This result is heavily weighted by a subgroup of women from the Hendrix trial, which had large numbers of participants and a longer follow up of one year; all the women had had a hysterectomy and the treatment used was conjugated equine oestrogen. The result for women with an intact uterus where oestrogen and progestogen combined were used also showed a statistically significant worsening of incontinence (RR 1.11, 95% CI 1.04 to 1.18).There was some evidence that oestrogens used locally (for example vaginal creams or tablets) may improve incontinence (RR 0.74, 95% CI 0.64 to 0.86). Overall, there were around one to two fewer voids in 24 hours and nocturnal voids amongst women treated with local oestrogen, and there was less frequency and urgency. No serious adverse events were reported although some women experienced vaginal spotting, breast tenderness or nausea.Women who were continent and received systemic oestrogen replacement, with or without progestogens, for reasons other than urinary incontinence were more likely to report the development of new urinary incontinence in one large study.The data were too few to address questions about oestrogens compared with or in combination with other treatments, different types of oestrogen or different modes of delivery.
Authors' conclusions: Local oestrogen treatment for incontinence may improve or cure it, but there was little evidence from the trials on the period after oestrogen treatment had finished and none about long-term effects. However, systemic hormone replacement therapy, using conjugated equine oestrogen, may make incontinence worse. There were too few data to reliably address other aspects of oestrogen therapy, such as oestrogen type and dose, and no direct evidence on route of administration. The risk of endometrial and breast cancer after long-term use suggests that oestrogen treatment should be for limited periods, especially in those women with an intact uterus.
Update of
-
Oestrogens for urinary incontinence in women.Cochrane Database Syst Rev. 2003;(2):CD001405. doi: 10.1002/14651858.CD001405. Cochrane Database Syst Rev. 2003. Update in: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD001405. doi: 10.1002/14651858.CD001405.pub2. PMID: 12804406 Updated. Review.
Similar articles
-
Mid-urethral sling operations for stress urinary incontinence in women.Cochrane Database Syst Rev. 2015 Jul 1;(7):CD006375. doi: 10.1002/14651858.CD006375.pub3. Cochrane Database Syst Rev. 2015. Update in: Cochrane Database Syst Rev. 2017 Jul 31;7:CD006375. doi: 10.1002/14651858.CD006375.pub4. PMID: 26130017 Updated. Review.
-
Oestrogen therapy for urinary incontinence in post-menopausal women.Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD001405. doi: 10.1002/14651858.CD001405.pub3. Cochrane Database Syst Rev. 2012. PMID: 23076892 Free PMC article. Review.
-
Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women.Cochrane Database Syst Rev. 2010 Sep 8;(9):CD007063. doi: 10.1002/14651858.CD007063.pub2. Cochrane Database Syst Rev. 2010. PMID: 20824855 Review.
-
Hormone replacement therapy in postmenopausal women: endometrial hyperplasia and irregular bleeding.Cochrane Database Syst Rev. 2004;(3):CD000402. doi: 10.1002/14651858.CD000402.pub2. Cochrane Database Syst Rev. 2004. Update in: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD000402. doi: 10.1002/14651858.CD000402.pub3. PMID: 15266429 Updated. Review.
-
Oestrogens for urinary incontinence in women.Cochrane Database Syst Rev. 2003;(2):CD001405. doi: 10.1002/14651858.CD001405. Cochrane Database Syst Rev. 2003. Update in: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD001405. doi: 10.1002/14651858.CD001405.pub2. PMID: 12804406 Updated. Review.
Cited by
-
Comparison of Low-Energy Radiofrequency Thermal Vaginal Therapy with Sham Treatment for Stress Urinary Incontinence in Postmenopausal Women: A Randomized Controlled Trial.Int J Womens Health. 2023 Nov 15;15:1779-1790. doi: 10.2147/IJWH.S431233. eCollection 2023. Int J Womens Health. 2023. PMID: 38020937 Free PMC article.
-
The Anatomical Pathogenesis of Stress Urinary Incontinence in Women.Medicina (Kaunas). 2022 Dec 20;59(1):5. doi: 10.3390/medicina59010005. Medicina (Kaunas). 2022. PMID: 36676629 Free PMC article. Review.
-
[Preventive activities in women. PAPPS update 2022].Aten Primaria. 2022 Oct;54 Suppl 1(Suppl 1):102471. doi: 10.1016/j.aprim.2022.102471. Aten Primaria. 2022. PMID: 36435585 Free PMC article. Spanish.
-
[Preventive activities in women's care].Aten Primaria. 2020 Nov;52 Suppl 2(Suppl 2):125-148. doi: 10.1016/j.aprim.2020.09.001. Aten Primaria. 2020. PMID: 33388112 Free PMC article. Spanish.
-
Anterior vaginal repair for urinary incontinence in women.Cochrane Database Syst Rev. 2017 Jul 31;7(7):CD001755. doi: 10.1002/14651858.CD001755.pub2. Cochrane Database Syst Rev. 2017. PMID: 28759116 Free PMC article. Review.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous