28 October 2011

Oestrogen use tied to bladder control problems

Postmenopausal women who take oestrogen for years are more likely to experience incontinence than those on the hormone for a shorter time or not at all.


Postmenopausal women who take oestrogen for years are more likely to experience incontinence than those on the hormone for a shorter time or not at all, a new study finds.

Of 167 women surveyed in the early 1990s and again in 2004, those who had taken oestrogen for five years or more were three to four times more likely to report bladder control problems in the second survey than women who had not taken oestrogen or took it for less than five years.

"Looking at a patient's history of oestrogen use may be an important factor in (gauging) their risk for developing urinary incontinence," said Dr Gina Northington, an author of the study, who specialises in urogynecology at Emory University in Atlanta.

Hot flashes

Some women take oestrogen after menopause to help with symptoms such as hot flashes and vaginal dryness.

For the study, published in the Journal Menopause, 167 postmenopausal women filled out questionnaires in 1993, stating whether they had never used oestrogen, used oestrogen for less than five years, or used it for five or more years.

Eleven years later, of the 167 women who said they didn't have incontinence problems in the first survey, 47 reported having a new case of urinary incontinence.

And more than 31 of those women said their incontinence made it difficult to perform daily tasks such as shopping, attending social events, visiting friends and exercising.

Of the 47 women with new bladder control problems, seven had used oestrogen for more than five years. That compares with just seven of 120 women without incontinence who had used oestrogen for that long.

Oestrogen may affect nerves

Northington pointed out the study had a few weaknesses. "We only asked women if they took hormones containing oestrogen," she said. "We didn't measure the level of oestrogen and we didn't ask about progesterone."

The reason why oestrogen therapy would affect bladder function is still not well understood.

"Some studies have suggested hormones such as oestrogen may influence nerves that control the bladder," said Dr Leslie Rickey, a gynaecologist who specialises in bladder problems at the University of Maryland Medical Center.

"Urinary problems increase with age," said Rickey, who was not part of the study. "We're not sure if it's due to the ageing process or oestrogen levels or the combination of the two."

Up to half of women 45 years and over have reported experiencing incontinence at least once in their lifetime, according to a menopause study of nearly 2,800 women that was funded by the National Institutes of Health.

Other risks

Rickey does find large studies helpful in spotting patterns in the relationship between bladder function and oestrogen, but it's difficult to apply the data to an individual patient.

"It's still not known which individual women on oestrogen therapy are at risk for developing bladder control problems," she said. Northington doesn't recommend stopping oestrogen but she does urge women to talk with their doctor before starting therapy.

"In addition to other risks associated with oestrogen such as breast cancer and blood clots, this is another reason to make sure oestrogen is taken for the shortest amount of time, if it needs to be taken," said Northington.

(Reuters Health, Linda Thrasybule, October 2011)

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Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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