Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial.
OBJECTIVE
To investigate the effects of the combination of pelvic floor muscle exercise (PFME) and estriol on postmenopausal stress incontinence (SI).


METHODS
Sixty-six patients with postmenopausal SI were randomized to a group treated with a combination of estriol (1 mg/d) and PFME (group A, n = 32) and a group treated with PFME alone (group B, n = 34). Efficacy was evaluated every three months based on stress scores obtained from a urinary incontinence (UI) questionnaire.


RESULTS
A significant decrease in stress score was observed in mild and moderate UI patients in both groups three months after the commencement of therapy (A and B, P < .0001). The therapeutic effect in group A was more prominent for up to 18 months in mild UI and for up to 12 months in moderate UI (A vs. B, P < .05). Kaplan-Meier analysis showed that the cumulative morbidity rate in mild SI patients was significantly lower in group A (0%) than in group B (12%, P < .005).


CONCLUSIONS
Combination therapy with estriol plus PFME was effective and is capable of serving as first-line treatment for mild SI.
Ishiko
O
O
Department of Obstetrics and Gynecology, Osaka City University Medical School, and Hanwa Sumiyoshi General Hospital, Osaka, Japan. ishikoo@msic.med.osaka-cu.ac.jp
Hirai
K
K
Sumi
T
T
Tatsuta
I
I
Ogita
S
S
D003131:Combined Modality Therapy; D004964:Estriol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010352:Patient Dropouts; D017773:Pelvic Floor / Q000503:physiopathology*; D017698:Postmenopause / Q000502:physiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*
D004964:Estriol