What is the available evidence for hormone replacement therapy in women with stress urinary incontinence?

Abstract

Objective: To examine the evidence for the effectiveness of estrogen replacement therapy, with or without progesterone, for the treatment of stress urinary incontinence (SUI) in hypoestrogenic women.

Methods: MEDLINE, DARE, CINAHL, Cochrane Central Register of Controlled Trials, and EMBASE databases were searched for studies, in all languages, that used estrogen therapy, with or without progesterone, in hypoestrogenic women with SUI. The following key words were used in the search: estrogen, hormone replacement therapy, female urinary incontinence, stress urinary incontinence, and urodynamic stress incontinence. Studies that did not specify a subgroup with SUI among women with mixed incontinence were excluded.

Results: Of the papers included in this evaluation, 14 were non-randomized studies of estrogen treatment with or without progesterone; 6 were randomized trials of estrogen alone, combined with other treatments; 4 were placebo-controlled randomized trials, 2 of which were with progesterone; and 2 were meta-analyses. A symptomatic or clinical improvement was detected only in nonrandomized studies; randomized trials did not suggest a benefit of estrogen therapy, with or without progesterone, among postmenopausal women with SUI.

Conclusions: Further research, ideally randomized placebo-controlled trials, is required to determine the risks and benefits of estrogen treatment alone in the management of SUI in postmenopausal women.