Elsevier

Obstetrics & Gynecology

Volume 97, Issue 1, January 2001, Pages 116-120
Obstetrics & Gynecology

Postmenopausal hormones and incontinence: the heart and Estrogen/Progestin Replacement Study

https://doi.org/10.1016/S0029-7844(00)01115-7Get rights and content

Abstract

Objective: To determine whether postmenopausal hormone therapy improves the severity of urinary incontinence.

Methods: We included measures of incontinence and voiding frequency in the Heart and Estrogen/Progestin Replacement Study, a randomized, blinded trial of the effect of hormone therapy among 2763 postmenopausal women younger than 80 years with coronary disease and intact uteri. This report includes 1525 participants who reported at least one episode of incontinence per week at baseline. Participants were randomly assigned to 0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate in one tablet daily (n = 768) or placebo (n = 757) and were followed for a mean of 4.1 years. Severity of incontinence was classified as improved (decrease of at least two episodes per week), unchanged (change of at most one episode per week), or worsened (increase of at least two episodes per week).

Results: Incontinence improved in 26% of the women assigned to placebo compared with 21% assigned to hormones, while 27% of the placebo group worsened compared with 39% of the hormone group (P = .001). This difference was evident by 4 months of treatment and was observed for both urge and stress incontinence. The number of incontinent episodes per week increased an average of 0.7 in the hormone group and decreased by 0.1 in the placebo group (P < .001).

Conclusion: Daily oral estrogen plus progestin therapy was associated with worsening urinary incontinence in older postmenopausal women with weekly incontinence. We do not recommend this therapy for the treatment of incontinence.

Section snippets

Materials and methods

The design, methods, baseline patient characteristics,8 and main findings9 of the trial have been published. Briefly, participants were postmenopausal women less than 80 years old with established coronary heart disease who had not had a hysterectomy. Participants were randomly assigned to treatment with daily oral conjugated estrogen (0.625 mg) and medroxyprogesterone acetate (2.5 mg) in one tablet (Prempro; Wyeth-Ayerst Research, Radnor, PA) or identical placebo. The randomization codes were

Results

Between January 1993 and September 1994, the 20 centers enrolled 2763 women. At the beginning of the trial, 1525 participants reported urinary incontinence at least once per week. Of these 1525 participants, 768 were randomly assigned to receive hormone therapy and 757 were assigned to placebo.

There were no significant differences between the treatment groups at baseline in demographic or reproductive characteristics, reported medical conditions, or use of incontinence medications. At baseline,

Discussion

Among women assigned to treatment with hormone therapy, incontinence was more likely to worsen and less likely to improve than among women assigned to placebo. There was no improvement among hormone-treated women in the frequency of either stress or urge incontinence and no reduction in either diurnal or nocturnal urinary frequency.

The urethra and trigone of the bladder are covered by nonkeratinized squamous epithelium of similar origin to the vagina.12 These tissues contain estrogen receptors4

References (30)

  • A Diokno et al.

    Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly

    J Urol

    (1986)
  • L.D Cardozo et al.

    Sex hormones, the menopause and urinary problems

    Gynecol Endocrinol

    (1995)
  • L.D Cardozo

    Role of estrogens in the treatment of female urinary incontinence

    J Am Geriatr Soc

    (1990)
  • J.A Fantl et al.

    Estrogen therapy in the management of urinary incontinence in postmenopausal womenA meta-analysis. First report of the Hormones and Urogenital Therapy Committee

    Obstet Gynecol

    (1994)
  • S Hulley et al.

    Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women

    JAMA

    (1998)
  • Cited by (352)

    • The impact of different intensities of exercise on body weight reduction and overactive bladder symptoms- randomised trial

      2019, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      Grady et al. [18] demonstrated that increased BMI was a significant predictor of combined urgency urinary incontinence and stress urinary incontinence. The results reported in the present study complement previously published findings from other authors [19–22]. Pinto et al [9].

    View all citing articles on Scopus

    Supported by Wyeth-Ayerst Research, Radnor, PA. Wyeth-Ayerst is a wholly owned subsidiary of American Home Products and manufactures Prempro, the medication used in this study.

    View full text