Oestrogens and overactive bladder

Abstract

Estrogens are known to have a major role in the function of the lower urinary tract although the role of exogenous estrogen replacement therapy in the management of women with lower urinary tract dysfunction remains controversial. Whilst for many years systemic and vaginal estrogen therapy was felt to be beneficial in the treatment of lower urinary and genital tract symptoms this evidence has recently been challenged by large epidemiological studies investigating the use of systemic hormone replacement therapy. Consequently the role of estrogen in the management of postmenopausal women with Overactive Bladder (OAB) remains uncertain. In addition the evidence base regarding the use of exogenous estrogen therapy has changed significantly over the last decade and has led to a major changes in current clinical practice. The aim of this article is to review the evidence for the role of estrogen therapy in the management of OAB focusing on current knowledge with regard to both systemic and local estrogen therapy as well as investigating the emerging role of combination therapy with antimuscarinic agents.

Administration of leuprolide acetate, a GnRH agonist, improves urodynamic parameters in ovariectomized rats

“…In the OVX and OVX + LA groups, both ovaries were surgically removed under deep anesthesia with methyl ether. Removal of ovaries generated bladder overactivity conditions as reported . As a control condition, in the SHAM group the ovaries were only exposed but not removed.…”

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

“…Although the role of estrogen therapy for vulvovaginal concerns in healthy postmenopausal women has been well established, the evidence to support a role of systemic estrogen therapy in the management of urinary tract symptoms is conflicting [Grady et al 2001;Hendrix et al 2005;Robinson et al 2014]. According to a 2012 Cochrane review [Marjoribanks et al 2012], systemic (oral) hormone therapy (HT) with unopposed estrogen results in worse incontinence symptoms than placebo [risk ratio (RR) 1.32; 95% confidence interval (CI): 1.17-1.48].…”

“…Estrogen use has also been recommended for the treatment of symptoms of overactive bladder (OAB) in postmenopausal women with vaginal atrophy [Ewies and Alfhaily, 2010;Robinson et al 2014]. Further, local estrogen has been shown to improve sexual desire, arousal, coital satisfaction and orgasm by increasing blood flow to the genital area, and consequently, improving vaginal lubrication and sensation in the vaginal tissues [North American Menopause Society, 2012;Goldstein and Alexander, 2005].…”

Œstrogénothérapie locale en urologie et pelvi-périnéologie. Revue de littérature

“…Robinson et al [30] soulignaient plus récemment dans une revue de littérature que l'OL était efficace sur les symptômes d'hyperactivité vésicale, même si elle ne peut être envisagée en 1 re intention seule du fait du manque de preuve. En revanche une association avec des antimuscariniques pourrait être envisagée pour ces patientes.…”