title: Association of change in estradiol to lower urinary tract symptoms during the menopausal transition.
abstract: OBJECTIVE
  To estimate the relationship between changes in estradiol (E2) levels over time and lower urinary tract symptoms in premenopausal women as they transition to menopause.
  
  
  METHODS
  A self-administered validated questionnaire to measure lower urinary tract symptoms was administered to 300 women at the 11th assessment period on an ongoing longitudinal Penn Ovarian Aging cohort study. The association between the change in E2 over time through the menopausal transition and lower urinary tract symptoms (urinary incontinence, filling symptoms, voiding dysfunction) was determined. Risk factors associated with lower urinary tract symptoms were determined by univariable analysis and multivariable linear regression.
  
  
  RESULTS
  Estradiol levels and menopausal stage at one point in time were not associated with lower urinary tract symptoms. Women with a sharp decline in E2 levels over time had significantly lower urinary incontinence scores in comparison with women without a change in E2 levels through the study period (mean+/-standard deviation 3.11+/-2.86 compared with 2.08+/-2.43, adjusted mean difference -0.93, 95% confidence interval [CI] -1.8 to -0.02). Women between the ages of 45 years to 49 years had significantly higher urinary incontinence scores than women woman age older than 55 years (1.59+/-1.86 compared with 3.04+/-2.93, adjusted mean difference 1.0, 95% CI 0.01-2.1). Women with a body mass index greater than 35 also had significantly higher urinary incontinence scores than women in the normal weight range, (3.53+/-3.16 compared with 1.98+/-2.52, adjusted mean difference 1.5, 95% CI 0.59-2.3) after adjusting for changes of E2 through the menopausal transition. High anxiety was associated with worsening scores in all three lower urinary tract symptoms domains (incontinence, filling, voiding).
  
  
  CONCLUSIONS
  Women with a sharp decline in E2 through the menopausal transition have significantly lower urinary incontinence scores. Urinary filling symptoms and voiding dysfunction were not associated with changes in E2 through the menopausal transition.
  
  
  METHODS
  II.
authors.affiliation: Division of Urogynecology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. manishgopal@yahoo.com
authors.forename: Manish
authors.initials: M
authors.lastname: Gopal
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Lily A
authors.initials: LA
authors.lastname: Arya
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Freeman
authors.forename: Hui
authors.initials: H
authors.lastname: Lin
authors.forename: Clarisa
authors.initials: C
authors.lastname: Gracia
mesh_terms: D015331:Cohort Studies; D004958:Estradiol / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D047648:Perimenopause / Q000097:blood*; D012307:Risk Factors; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000097:blood*
chemical_list: D004958:Estradiol