CFAH logoSome women take hormone replacement therapy (HRT) to reduce the post-menopausal symptoms. This therapy is claimed to have its benefits as well as its pitfalls. Experts have now claimed that they have proof that HRT could play a part in causing incontinence.

Several women experience incontinence. It is said to be an unconscious and awkward outflow of urine that may result in social isolation and even disgrace. There are various types of urinary incontinence like stress and urge incontinence. Stress incontinence could arise when someone is coughing or sneezing, while urge incontinence may happen when one feels an unexpected powerful urge to urinate.

June Cody, a methodologist at the Cochrane Incontinence Review Group at the University of Aberdeen in Scotland, commented, “Our main finding, which comes in particular from one huge trial, is that one type of HRT — systemic conjugated equine estrogen (CEE) — may make urinary incontinence worse. In addition, in this large trial, women who did not have incontinence at first were more likely to develop incontinence than those who took a placebo.”

Cody and colleagues also discovered that considerably more women who used local estrogen accounted that their incontinence symptoms improved as opposed to women who used a placebo. This outcome comes from small studies, nevertheless, which might have had drawbacks.

Cody mentioned, “The original (2003) Cochrane review on incontinence grouped women according to different types of incontinence — stress, urge or mixed. In this update, we rearranged things to look separately at local or systemic delivery. We then honed in on the different types of estrogen. When we looked at the research with CEE, it seemed to make all types of incontinence worse.”

Around 33 trials were conducted and it included roughly 19,313 incontinent post-menopausal women. In the review as a whole, about 9,417 women were given estrogen systemically, from oral tablets, skin patches or subcutaneous implants. Another 735 women were given estrogen locally via a vaginal cream, tablet, vaginal ring or other device. The studies incorporated control groups of women who were given a placebo or a different treatment. It was seen that half of the trials were conducted in the US.

Cody mentioned that the outcome of the two trials, which integrated around 17,642 women, dominated the findings. One study accounted for a division of women from the Women’s Health Initiative, which gathered incontinence data on about 23,296 women, roughly 16,117 were incontinent. The second leading study incorporated about 1,525 women with incontinence.

The findings of both studies were found to be similar, whether women were taking estrogen alone, or estrogen and progestogen i.e. for women with an unharmed uterus. Incontinence deteriorated for those using HRT with conjugated equine estrogen. Strangely smaller studies proposed that systemic estrogen may facilitate incontinence. Women in these trials, were given various kinds of estrogen, like estriol or estradiol but not CEE. One-fourth of women on systemic estrogen accounted for vaginal bleeding and one-fifth reported for breast tenderness during the trials.

Cody, who is also a member of the Academic Urology Unit at the University of Aberdeen, remarked, “The women in the largest study “were reportedly healthy, post-menopausal women and, on average, their incontinence got worse if they were allocated CEE. This is what the data show from a randomized trial — the best level of evidence for comparing different interventions.”

Charla Blacker, M.D., of the Henry Ford Health System in Detroit, who did not take part in the review, mentioned that doctors ought to supervise the way estrogen therapy is administered by local estrogen therapy or systemic hormone treatments. This could find out whether incontinence may get better or deteriorate further.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care.