Association between menopausal transition stages and developing urinary incontinence.
OBJECTIVE
To estimate whether menopause transition stage is independently associated with the development of incontinence symptoms.


METHODS
We conducted a longitudinal analysis, using discrete proportional hazards models, of women who were continent at baseline in the Study of Women's Health Across the Nation (SWAN), a multicenter, multiracial, multiethnic prospective cohort study of community-dwelling midlife women transitioning through menopause. At baseline and each of the six annual visits, SWAN elicited frequency and type of incontinence in a self- administered questionnaire and classified menopausal stage from menstrual bleeding patterns.


RESULTS
Compared with premenopause, being in the early perimenopause (incidence 17.8 per 100 woman years) made it 1.34 times and in the late perimenopause (incidence 14.5 per 100 woman years) made it 1.52 times more likely for women to develop monthly or more frequent incontinence. In contrast, women in postmenopause (incidence 8.2 per 100 woman years) were approximately one half as likely to develop this degree of incontinence. This pattern of association across the menopausal transition was similar for stress and urge incontinence. However, menopausal stage was not associated with developing more frequent incontinence (leaking several times per week or more). Worsening anxiety symptoms, a high baseline body mass index, weight gain, and new onset diabetes were associated with developing more frequent incontinence.


CONCLUSIONS
Menopausal transition stage was associated with developing monthly or more frequent but not weekly or more frequent incontinence, suggesting that only infrequent incontinence symptoms were attributable to the perimenopause. Because modifiable factors such as anxiety, weight gain, and diabetes were associated with developing more frequent incontinence, determining whether healthy life changes and treating medical problems can prevent incontinence is a priority.


METHODS
II.
Waetjen
L Elaine
LE
From the Department of Obstetrics and Gynecology and Department of Statistics, University of California, Davis, Davis, California; Department of Statistics, University of California, Irvine, Irvine, California; Department of Medicine, Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; School of Nursing, University of Michigan, Ann Arbor, Ann Arbor, Michigan; Kaiser Permanente Department of Research, Oakland, California; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Ann Arbor, Michigan; and Division of Epidemiology, Department of Public Health Sciences, University of California, Davis, David, California.
Ye
Jingjing
J
Feng
Wen-Ying
WY
Johnson
Wesley O
WO
Greendale
Gail A
GA
Sampselle
Carolyn M
CM
Sternfield
Barbara
B
Harlow
Siobàn D
SD
Gold
Ellen B
EB
D000328:Adult; D001007:Anxiety / Q000150:complications; D015992:Body Mass Index; D048909:Diabetes Complications; D005006:Ethnicity; D005260:Female; D006801:Humans; D008019:Life Style; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D047648:Perimenopause / Q000502:physiology; D017698:Postmenopause / Q000502:physiology; D017697:Premenopause / Q000502:physiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015430:Weight Gain