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February 22, 2005 (HealthDay News)
Data
from the Women's Health Initiative (WHI)
-- the major study of hormonal therapy -- found that risks
for developing
one kind or another of urinary incontinence were significantly
greater for women who got the therapy than for those who didn't.
Many experts are now reluctant to recommend hormone replacement
therapy (HRT) to incontinent patients, and these findings may
support that trend.
"Would I prescribe hormonal treatment for
urinary incontinence? No, never," said Dr. Jean Fourcroy, a
trustee of the National Association for Continence.
The findings
appear in the Feb. 23 issue of the Journal of the American
Medical Association.
Researchers led by Dr. Susan Hendrix of
Wayne State University School of Medicine, in Detroit, looked
over data on nearly 23,300 women aged 50 to 79. They focused
on symptoms of urinary incontinence occurring within one year
of initiating HRT.
The team reported that the incidence of
developing stress incontinence (urinary incontinence triggered
by stressors such as heavy lifting or even coughing) more than
doubled for women prescribed estrogen alone as a hormone therapy,
compared to women given a placebo.
Urge incontinence, caused
by an involuntary contraction of bladder muscles, was 32 percent
more likely in women taking estrogen-only HRT, while the incidence
of mixed incontinence, which has a multitude of causes, was
increased by 79 percent.
Hormone-related increases in risk
for stress or mixed incontinence were somewhat lower in women
getting a combination of hormones, such as estrogen plus progestin,
the researchers note. And in the case of urge incontinence,
mixed hormonal therapy appeared to confer no increase in risk
over a placebo.
Women already diagnosed with urinary incontinence
at the start of the study reported an increase in the frequency
and degree of the problem after being prescribed hormonal therapy,
the researchers add.
The report on urinary incontinence and
hormonal therapy couldn't have been made earlier because the
complete Women's Health Initiative trial didn't end until February
2004 and "it takes a long time to be sure the records are complete
and to get the information together," explained Hendrix, a
professor of obstetrics and gynecology.
The finding that hormonal
therapy worsened the outlook was "quite surprising," Hendrix
said, and the treatment probably is still being prescribed
for incontinence by many physicians.
"We have to educate patients
and physicians about the effects of the medication so we can
treat patients better," she said.
The report is yet another
blow for HRT from data arising from the Women's Health Initiative.
In July 2002, one arm of the study was unexpectedly halted
after results found combined therapy increased women's risks
for heart attack, stroke, blood clots and breast cancer. Sales
of HRT have fallen sharply since that time.
This finding of
an increased risk of urinary incontinence "is something of
a surprise, because smaller trials have shown a benefit," said
Dr. Catherine E. DuBeau, an associate professor of medicine
at the University of Chicago, who wrote an accompanying editorial
in the journal.
Her editorial advises that "clinicians should no longer prescribe long-term oral
conjugated estrogens for treatment of urge, stress or mixed urinary incontinence
in postmenopausal women aged 50 years or older."
However, the finding "is not
the final word on using estrogens to treat urinary incontinence," DuBeau said. "There
is still a lot we don't know about [the effectiveness of] topical estrogens," such
as lotions or creams.
The most important result of the study "will be to get the word out to woman
that they don't have to suffer from urinary incontinence," DuBeau said. Many
women find the issue so embarrassing that they never tell their doctors about
it, she said, even though a variety of helpful treatments are available, starting
with behavioral therapy and moving on to drug treatment, if necessary. An implantable
device has also been approved for use in extreme cases, she said.
Fourcroy said
the study does have some weaknesses that could benefit from further analysis.
"One
of the biggest things is that relief of urinary incontinence is associated with
weight loss," Fourcroy said, and the new report has no information on participants'
body-mass index, a measure of obesity. "We might see some subset differences
if we looked at body-mass index information," she said.
But the bottom line,
she said, is that hormonal therapy "is not the way to go."
More information
The
various forms of urinary incontinence, their causes and treatment, are outlined
by the National Association for
Continence.
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