EFFICACY OF ESTROGEN SUPPLEMENTATION IN THE TREATMENT OF URINARY-INCONTINENCE

Objective: To assess the efficacy of cyclic postmenopausal hormone rep lacement in treating urinary incontinence in hypoestrogenic women. Met hods: Eighty-three hypoestrogenic women complaining of urinary inconti nence were included. All patients were community-dwelling, age 45 year s or older, with involuntary loss of urine occurring at least once a w eek and urodynamic evidence of genuine stress incontinence and/or detr usor instability. Evaluation consisted of a comprehensive clinical and urodynamic research protocol. The hypoestrogenic entry criterion was a plasma estradiol level of 30 pg/mL or less. Parabasal cells on vagin al smears were also monitored. The primary outcome was the number of i ncontinent episodes per week, as documented on a standardized urinary diary. Secondary outcomes were the quantity of fluid loss, voluntary d iurnal and nocturnal micturition frequency, generic and condition-spec ific health-related quality of life measurements, and patient satisfac tion. A randomized, placebo-controlled, double-blind design was used. Subjects in the treatment group were given conjugated equine estrogens (0.625 mg) and medroxyprogesterone (10 mg) cyclically for 3 months. C ontrols received placebo tablets. Results: (All results are presented as mean +/- standard deviation.) Subjects were 67 +/- 9 years old. The menopause duration was 18 +/- 11 years. The duration of incontinence was 9 +/- 9 years. Estradiol level at baseline was 9 +/- 9 pg/mL, and the parabasal cell count was 42 +/- 44%. The number of incontinent epi sodes at baseline was 13 +/- 10 for the treatment group and 16 +/- 4 f or controls. No significant changes occurred in the number of incontin ent episodes after treatment: 10 +/- 10 for the treatment group, and 1 3 +/- 14 for the controls (P = .7). Also, fluid loss was not changed: 176 +/- 106 g for the treatment group and 64 +/- 88 g for the control group at baseline, and 101 +/- 150 and 51 +/- 69 g after treatment, re spectively (P = .7). There were no significant differences for either diurnal or nocturnal voluntary micturition, quality of life measures, or patient's perception of improvement. Conclusion: Three-month cyclic hormone replacement therapy did not affect either clinical or quality of life variables of incontinent, hypoestrogenic women. Long-term eff ects are unlikely to be substantially different. The use of estrogen s upplementation as preventive or adjuvant therapy was not evaluated in this study.