Background & Aims
Low estrogen levels could contribute to development of fecal incontinence (FI) in women after menopause by altering neuromuscular continence mechanisms. However, studies have produced conflicting results on the association between menopausal hormone therapy (MHT) and risk of FI.
Methods
We studied the association between MHT and risk of FI among 55,828 post-menopausal women (mean age 73 years) who participated in the Nurses’ Health Study, enrolled since 2008, with no report of FI. We defined incident FI as a report of at least 1 liquid or solid FI episode per month during 4 years of follow up from self-administered, biennial questionnaires, administered in 2010 and 2012. We used Cox proportional hazards models to calculate multivariate-adjusted hazard ratios (HRs) and 95% CIs for FI risk in women receiving MHT, adjusting for potential confounding factors.
Results
During more than 185,000 person-years of follow up, there were 6834 cases of incident FI. Compared with women who never used MHT, the multivariate HR for FI was 1.26 (95% CI, 1.18–1.34) for past users of MHT and 1.32 (95% CI, 1.20–1.45) for current users. The risk of FI increased with longer duration of MHT use (P trend ≤.0001) and decreased with time since discontinuation. There was an increased risk of FI among women receiving MHT that contained a combination of estrogen and progestin (HR, 1.37; 95% CI 1.10–1.70) compared to estrogen monotherapy.
Conclusions
Current or past use of MHT was associated with a modestly increased risk of FI among post-menopausal women in the Nurses’ Health Study. These results support a potential role for exogenous estrogens in the impairment of the fecal continence mechanism.