Postmenopausal hormone therapy: does it cause incontinence?
OBJECTIVE
To estimate the effect of hormone therapy on risk of stress and urge urinary incontinence.


METHODS
The Heart Estrogen/progestin Replacement Study was a randomized, placebo-controlled, double-blinded trial to evaluate daily oral conjugated estrogen (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) therapy for the prevention of heart disease events in women with established heart disease. The 1,208 participants in Heart Estrogen/progestin Replacement Study who reported no loss of urine in the previous 7 days at baseline are included in this analysis.


RESULTS
During 4.2 years of treatment, 64% of women randomly assigned to hormone therapy compared with 49% of those assigned to placebo reported weekly incontinence (P < .001). The higher risk of incontinence in the hormone group was evident at 4 months, persisted throughout the treatment period, and was independent of the age of the women. The odds ratios for weekly incontinence among women on hormone therapy compared with placebo were 1.5 for urge incontinence (95% confidence interval [CI] 1.2-1.8; P < .001) and 1.7 for stress incontinence (95% CI 1.5-2.1; P < .001). Four years of treatment with hormone therapy caused an excess risk of 12% for weekly urge incontinence and 16% for weekly stress incontinence; the corresponding numbers needed to harm were 8.6 (95% CI 5.8-16.6) and 6.2 (95% CI 4.6-9.4).


CONCLUSIONS
Estrogen plus progestin therapy increases risk of urge and stress incontinence within 4 months of beginning treatment.


METHODS
I.
Steinauer
Jody E
JE
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA. steinauerrj@obgyn.ucsf.edu
Waetjen
L Elaine
LE
Vittinghoff
Eric
E
Subak
Leslee L
LL
Hulley
Stephen B
SB
Grady
Deborah
D
Lin
Feng
F
Brown
Jeanette S
JS
D000284:Administration, Oral; D000368:Aged; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D014549:Urinary Incontinence / Q000139:chemically induced*
D004338:Drug Combinations; D004966:Estrogens, Conjugated (USP); D017258:Medroxyprogesterone Acetate