title: Factors associated with worsening and improving urinary incontinence across the menopausal transition.
abstract: OBJECTIVE
  To evaluate whether the menopausal transition is associated with worsening of urinary incontinence symptoms over 6 years in midlife women.
  
  
  METHODS
  We analyzed data from 2,415 women who reported monthly or more incontinence in self-administered questionnaires at baseline and during the first six annual follow-up visits (1995-2002) of the prospective cohort Study of Women's Health Across the Nation. We defined worsening as a reported increase and improving as a reported decrease in frequency of incontinence between annual visits. We classified the menopausal status of women not taking hormone therapy annually from reported menstrual bleeding patterns and hormone therapy use by interviewer questionnaire. We used generalized estimating equations methodology to evaluate factors associated with improving and worsening incontinence from year to year.
  
  
  RESULTS
  Over 6 years, 14.7% of incontinent women reported worsening, 32.4% reported improvement, and 52.9% reported no change in the frequency of incontinence symptoms. Compared with premenopause, perimenopause and postmenopause were not associated with worsening incontinence; for example, early perimenopause was associated with improvement (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.06-1.35) and postmenopause reduced odds of worsening (OR 0.80; 95% CI 0.66-0.95). Meanwhile, each pound of weight gain increased odds of worsening (OR 1.04; 95% CI 1.03-1.05) and reduced odds of improving (OR 0.97; 95% CI 0.96-0.98) incontinence.
  
  
  CONCLUSIONS
  In midlife incontinent women, worsening of incontinence symptoms was not attributable to the menopausal transition. Modifiable factors such as weight gain account for worsening of incontinence during this life stage.
authors.affiliation: Department of Obstetrics and Gynecology and Statistics, University of California, Davis, California, USA. lewaetjen@ucdavis.edu
authors.forename: L Elaine
authors.initials: LE
authors.lastname: Waetjen
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Feng
authors.forename: Jingjing
authors.initials: J
authors.lastname: Ye
authors.forename: Wesley O
authors.initials: WO
authors.lastname: Johnson
authors.forename: Gail A
authors.initials: GA
authors.lastname: Greendale
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Sampselle
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfield
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Gold
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D047648:Perimenopause / Q000502:physiology*; D014481:United States; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology*; D015430:Weight Gain / Q000502:physiology