Effects of Oral Estrogen and Progestin on the Lower Urinary Tract Among Female Nursing Home Residents

Ouslander, Joseph G.; Greendale, Gail A.; Uman, Gwen; Lee, Carol; Paul, W. E.; Schnelle, John F.

doi:10.1046/j.1532-5415.2001.49160.x

Cited by 62 publications

(40 citation statements)

References 23 publications

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“…An indwelling estradiol vaginal ring has also been shown to reduce recurrent UTI in postmenopausal women but may difficult to place and lead to local complications in some frail elderly women [31]. In incontinent elderly women in nursing homes, oral estrogen with progestin was effective in improving atrophic vaginitis but not in improving continence or reducing UTIs [32]. More recently, an estriol pessary was not as effective as a pessary with nitrofurantoin in reducing UTIs in women.…”

Section: Hormonalmentioning

confidence: 98%

Urinary tract infections in the frail elderly: Issues for diagnosis, treatment and prevention

Richards

2004

Int Urol Nephrol

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Urinary tract infections (UTIs) are among the most common infections in frail elderly adults, whether they are community dwelling, live in long term care facilities (LTCFs) or are hospitalized. UTIs cause substantial morbidity and mortality in frail elderly men and women. While many major risk factors in these individuals may not be modifiable, improved attention to incontinence management, judicious use of antimicrobials and urinary catheters, and, in women, appropriate use of topical estrogen may be useful in reducing UTIs. Future strategies may also include the appropriate use of new urinary catheter technology and emerging vaccines.

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Section: Hormonalmentioning

confidence: 98%

Urinary tract infections in the frail elderly: Issues for diagnosis, treatment and prevention

Richards

2004

Int Urol Nephrol

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“…This increases the reservoir of urinary pathogens and changes the microbiology of the woman with postmenopausal urinary tract infections (UTI) in the more acidic environment that results. However, although the epidemiology of UTI changes over the life cycle, the risk of a UTI does not appear to be significantly affected by estrogen status [22][23][24][25][26]. Indeed, those women taking higher daily doses of ET were found to be at an increased risk of UTI compared with those not undergoing ET [25].…”

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confidence: 72%

Menopause hormonal therapy from the urologist’s perspective

Lightner¹

2006

Curr Urol Rep

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Many of the paradigms about hormone-replacement therapy in the postmenopausal female have changed drastically recently. Estrogen was thought to be cardioprotective for women until the landmark Heart and Estrogen/progestin Replacement Study [1] and the twin Women's Health Initiative studies [2,3] confirmed that neither combination estrogen with progesterone therapy (EPT) nor estrogen therapy (ET) alone are protective of coronary events in women with established coronary vascular disease. Sex steroid supplementation for female sexual dysfunction is widely promoted, despite sparse evidence of use outside of those with hypopituitary deficiency [4] or surgically induced menopause [5]. Given the increased risk of cardiac events, stroke [6], breast [7-9], endometrial [10] and ovarian cancers [11][12][13], and the aromatization of androgens to estrogenic compounds in fatty tissues and muscle [14,15] with the use of ET and EPT, a risk-benefit assessment for sex steroid supplementation for women with genitourinary complaints appears to be limited to short-term local estrogen therapy for vulvovaginal complaints in patients with documented vaginal atrophy.Indeed, the effects of menopause on urogenital function also have been upturned. Menopause is symptomatic in variable percentages of women, with vasomotor symptoms occurring in most women, of whom 50% will continue to have symptoms for at least 5 years [16][17][18]. Estrogen-related atrophic vaginitis produces symptoms of vaginal burning, itching, and secondary dyspareunia and is responsive to estrogen supplementation in 60% of the case [19]. Using a locally applied estrogen cream is as effective as systemic use in the treatment of atrophic vaginitis [20] and is recommended [21]. Determining if vulvovaginal complaints are the result of vaginal atrophy prior to instituting estrogen therapy is accomplished by vaginal cytology, which will show the characteristic increase in basal and parabasal cells.It remains clear that gradual loss of estrogen results in lower glycogen production by the now thinning vaginal epithelium. This reduction reduces the population of glycogen-dependent lactobacilli, allowing coliform bacteria to populate the vagina. This increases the reservoir of urinary pathogens and changes the microbiology of the woman with postmenopausal urinary tract infections (UTI) in the more acidic environment that results. However, although the epidemiology of UTI changes over the life cycle, the risk of a UTI does not appear to be significantly affected by estrogen status [22][23][24][25][26]. Indeed, those women taking higher daily doses of ET were found to be at an increased risk of UTI compared with those not undergoing ET [25]. The greatest risk for a community-acquired UTI in the postmenopausal female is her lifetime history of UTI [26,27].Likewise, despite older studies to the contrary, estrogen replacement does not appear to significantly alter the recurrence rate for UTI. A double-blind, randomized, placebo-controlled trial (RPCT) of low-dose ET for recurrent U...

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“…In addition, the effects of oral estrogens and progestogens on the lower urinary tract were assessed in 32 female nursing home residents [46] with an average age of 88 years. Subjects were randomly allocated to treatment with oral estrogen and progesterone or placebo for 6 months.…”

Section: Systemic Hormone Replacement Therapy and Urinary Incontinencementioning

confidence: 99%

Overactive bladder in the female patient: The role of estrogens

Robinson

Cardozo²

2007

Curr Bladder Dysfunct Rep

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The prevalence of urinary incontinence is known to increase with age, affecting 15% to 35% of communitydwelling women older than 60 years of age, and other studies report a prevalence of 49% in women older than 65 years. Epidemiologic studies have implicated estrogen deficiency in the etiology of lower urinary tract symptoms, although to date the role of estrogen replacement therapy is controversial. The aim of this paper is to review the recent evidence regarding the effect of estrogen in lower urinary tract dysfunction, with a particular emphasis on the management of symptoms suggestive of overactive bladder in postmenopausal women.

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Effects of Oral Estrogen and Progestin on the Lower Urinary Tract Among Female Nursing Home Residents

Cited by 62 publications

References 23 publications

Urinary tract infections in the frail elderly: Issues for diagnosis, treatment and prevention

Urinary tract infections in the frail elderly: Issues for diagnosis, treatment and prevention

Menopause hormonal therapy from the urologist’s perspective

Overactive bladder in the female patient: The role of estrogens

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