Association between menopausal transition stages and developing urinary incontinence

Abstract

Objective: To estimate whether menopause transition stage is independently associated with the development of incontinence symptoms.

Methods: We conducted a longitudinal analysis, using discrete proportional hazards models, of women who were continent at baseline in the Study of Women's Health Across the Nation (SWAN), a multicenter, multiracial, multiethnic prospective cohort study of community-dwelling midlife women transitioning through menopause. At baseline and each of the six annual visits, SWAN elicited frequency and type of incontinence in a self- administered questionnaire and classified menopausal stage from menstrual bleeding patterns.

Results: Compared with premenopause, being in the early perimenopause (incidence 17.8 per 100 woman years) made it 1.34 times and in the late perimenopause (incidence 14.5 per 100 woman years) made it 1.52 times more likely for women to develop monthly or more frequent incontinence. In contrast, women in postmenopause (incidence 8.2 per 100 woman years) were approximately one half as likely to develop this degree of incontinence. This pattern of association across the menopausal transition was similar for stress and urge incontinence. However, menopausal stage was not associated with developing more frequent incontinence (leaking several times per week or more). Worsening anxiety symptoms, a high baseline body mass index, weight gain, and new onset diabetes were associated with developing more frequent incontinence.

Conclusion: Menopausal transition stage was associated with developing monthly or more frequent but not weekly or more frequent incontinence, suggesting that only infrequent incontinence symptoms were attributable to the perimenopause. Because modifiable factors such as anxiety, weight gain, and diabetes were associated with developing more frequent incontinence, determining whether healthy life changes and treating medical problems can prevent incontinence is a priority.

Level of evidence: II.

Figure 1. Flow Diagram Showing Identification of Women Included in Analytic Cohort

* Two women were missing incontinence data at baseline. † Reported monthly or more incontinence. Subject of another investigation (10) § Those deceased, who voluntarily withdrew or could not be contacted for 2 or more visits by year 6.

Figure 2. Incidence of Any, Stress and Urge Urinary Incontinence per 100 Woman Years by Menopause Status Over 6 Years in SWAN

Any UI: Premenopause (N = 151 per 911 woman years), Early peri-menopause (N = 486 per 2718 woman years), Late peri-menopause (N = 62 per 429 woman years), Postmenopause (N = 67 per 813 woman years). Stress UI: Premenopause (N = 109 per 972 woman years), Early peri-menopause (N = 376 per 3069 woman years), Late peri-menopause (N = 36 per 490 woman years), Postmenopause (N = 54 per 1017 woman years). Urge UI: Premenopause (N = 79 per 1024 woman years), Early peri-menopause (N = 281 per 3317 woman years), Late peri-menopause (N = 48 per 564 woman years), Postmenopause (N = 43 per 1104 woman years).