title: Efficacy of estrogen supplementation in the treatment of urinary incontinence. The Continence Program for Women Research Group.
abstract: OBJECTIVE
  To assess the efficacy of cyclic postmenopausal hormone replacement in treating urinary incontinence in hypoestrogenic women.
  
  
  METHODS
  Eighty-three hypoestrogenic women complaining of urinary incontinence were included. All patients were community-dwelling, age 45 years or older, with involuntary loss of urine occurring at least once a week and urodynamic evidence of genuine stress incontinence and/or detrusor instability. Evaluation consisted of a comprehensive clinical and urodynamic research protocol. The hypoestrogenic entry criterion was a plasma estradiol level of 30 pg/mL or less. Parabasal cells on vaginal smears were also monitored. The primary outcome was the number of incontinent episodes per week, as documented on a standardized urinary diary. Secondary outcomes were the quantity of fluid loss, voluntary diurnal and nocturnal micturition frequency, generic and condition-specific health-related quality of life measurements, and patient satisfaction. A randomized, placebo-controlled, double-blind design was used. Subjects in the treatment group were given conjugated equine estrogens (0.625 mg) and medroxyprogesterone (10 mg) cyclically for 3 months. Controls received placebo tablets.
  
  
  RESULTS
  (All results are presented as mean +/- standard deviation.) Subjects were 67 +/- 9 years old. The menopause duration was 18 +/- 11 years. The duration of incontinence was 9 +/- 9 years. Estradiol level at baseline was 9 +/- 9 pg/mL, and the parabasal cell count was 42 +/- 44%. The number of incontinent episodes at baseline was 13 +/- 10 for the treatment group and 16 +/- 4 for controls. No significant changes occurred in the number of incontinent episodes after treatment: 10 +/- 10 for the treatment group, and 13 +/- 14 for the controls (P = .7). Also, fluid loss was not changed: 176 +/- 106 g for the treatment group and 64 +/- 88 g for the control group at baseline, and 101 +/- 150 and 51 +/- 69 g after treatment, respectively (P = .7). There were no significant differences for either diurnal or nocturnal voluntary micturition, quality of life measures, or patient's perception of improvement.
  
  
  CONCLUSIONS
  Three-month cyclic hormone replacement therapy did not affect either clinical or quality of life variables of incontinent, hypoestrogenic women. Long-term effects are unlikely to be substantially different. The use of estrogen supplementation as preventive or adjuvant therapy was not evaluated in this study.
authors.affiliation: Department of Obstetrics and Gynecology, Virginia Commonwealth University/Medical College of Virginia, Richmond, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Fantl
authors.forename: R C
authors.initials: RC
authors.lastname: Bump
authors.forename: D
authors.initials: D
authors.lastname: Robinson
authors.forename: D K
authors.initials: DK
authors.lastname: McClish
authors.forename: J F
authors.initials: JF
authors.lastname: Wyman
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D004338:Drug Combinations; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008525:Medroxyprogesterone / Q000627:therapeutic use; D008875:Middle Aged; D045167:Progesterone Congeners / Q000627:therapeutic use; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D004338:Drug Combinations; D004966:Estrogens, Conjugated (USP); D045167:Progesterone Congeners; D008525:Medroxyprogesterone