The effects of hormones on urinary incontinence in postmenopausal women

Abstract

It has been established that the lower urinary tract is sensitive to the effects of estrogen, sharing a common embryological origin with the female genital tract, the urogenital sinus. Urge urinary incontinence is more prevalent after the menopause, and the peak prevalence of stress incontinence occurs around the time of the menopause. Many studies, however, indicate that the prevalence of stress incontinence falls after the menopause. Until recently, estrogen, usually as part of a hormone replacement therapy (HRT) regimen, was used for treatment of urinary incontinence in postmenopausal women. Although its use in the treatment of vaginal atrophy is well established, the effect of HRT on urinary continence is controversial. A number of randomized, placebo-controlled trials have examined the effects of estrogen, or estrogen and progestogen together, in postmenopausal continence and concluded that estrogens should not be used for the treatment of urge or stress incontinence. In this paper, we will review these recent studies and examine the evidence for the effects of estrogen on the postmenopausal urogenital tract.

Menopause, hormone treatment and urinary incontinence at midlife

“…Progestin receptors are also to be found in the entire female genital tract, although in less constant fashion than oestrogen receptors. Progestin appears to have a detrimental effect on continence, by reducing muscle tone of bladder and urethra [10].…”

“…the existence of (oestrogen and progestin) hormonal receptors in the epithelial tissues of bladder, urethra and trigone and also in the vagina, uterosacral ligaments, levator ani and puborectal muscles [10]. The other argument supporting this relation is clinical observation of an increase in the prevalence of overactive bladder (OAB) syndrome after the menopause.…”

Urinary incontinence, related factors and menopause-related quality of life in mid-aged women assessed with the Cervantes Scale

“…Despite this, several reports have failed to demonstrate that hormone therapy (HT) improves urinary symptoms (i.e. incontinence, urge syndrome) in postmenopausal women [7][8][9][10][11]. Important to state is that subjective sensation related to UI does not always correlate with urodynamic findings [12].…”

Recognizing and Treating Urogenital Atrophy in Postmenopausal Women

“…Because estrogen loss is associated with a loss of collagen content and atrophic changes in the tissues of the pelvic floor, estrogen deficiency also may play a role in the development or acceleration of the signs and symptoms of pelvic organ prolapse, 31 especially in women who sustained damage to their pelvic floor during childbirth.…”