Incontinence not helped by estrogen therapy

Estrogen is not a useful treatment for a leaky bladder in postmenopausal women. In fact, this hormone therapy seems to increase the risk of urinary incontinence in healthy women and worsen it in those who already have this problem.

Estrogen "with or without progestin should not be prescribed for the prevention or relief of urinary incontinence," Dr. Susan L. Hendrix, from Wayne State University in Detroit, and colleagues conclude.

The findings, which appear in the Journal of the American Medical Association, are based on a study of 23,296 healthy postmenopausal women who participated in the Women's Health Initiative (WHI) trial.

As part of the WHI trial, the subjects were randomly selected to receive estrogen plus progestin, estrogen alone, or inactive "placebo". Earlier results from the WHI trial linked estrogen therapy to an increased risk of heart attack, stroke, and breast cancer.

Hormone therapy was associated with an increased risk for all types of urinary incontinence, particularly stress incontinence in which leakage occurs with actions that raise abdominal pressure, such as laughing or coughing.

For women who already had urinary incontinence, treatment with either estrogen or estrogen plus progestin was associated with increasing urinary frequency. Moreover, such therapy was tied to urinary incontinence that limited daily activities and reduced quality of life.

In a related editorial, Dr. Catherine E. DuBeau, from the University of Chicago, comments that Hendrix's team has "performed an important service by placing urinary incontinence among ranks of other significant women's health problems that warrant formidable organizational, funding, and analysis efforts."

SOURCE: Journal of the American Medical Association, February 23, 2005.