HRT linked to increase in urinary incontinence risk: but other research suggests estrogen may protect against irritative symptoms. (Symptoms in 7% on Estrogen, 1% on Placebo).

NEW ORLEANS -- Increasing evidence suggests that hormone replacement therapy, once thought to be protective against urinary incontinence, may actually increase a woman's risk for the disorder, experts said at the annual meeting of the North American Menopause Society.

In a poster presentation, Dr. Steven Goldstein of New York University New York, and his associates found that among 158 women randomly assigned to take 0.625 mg conjugated equine estrogen daily for 3 years, 7% had new or worsened episodes of urinary incontinence, compared with 1.3% among those women who took a placebo, a difference that was statistically significant.

Raloxifene, however, was not associated with elevated risks of urinary incontinence. Among the 309 women who took low-dose (60 mg/day) and high-dose (150 mg/day) raloxifene, the rates of urinary incontinence were 0.7% and 0.6%, respectively.

In addition, all the women in the raloxifene groups who reported preexisting incontinence at baseline experienced improvement, according to findings from the study, which was funded by Lilly Research Laboratories, the Indianapolis-based manufacturer of raloxifene (Evista). The prevalence of incontinence at baseline was similar across all groups.

Still, these findings need to be weighed against those of dozens of studies showing that estrogen is actually protective against irritative symptoms of urinary incontinence, Dr. Douglass Hale, codirector of the female pelvic medicine and reconstructive surgery fellowship at Indiana University! Methodist Hospital, Indianapolis, said in an interview Dr. Hale is a former paid consultant to Wyeth-Ayerst Pharmaceuticals, which markets estrogen, but is no longer affiliated with the company.

While estrogen has never been shown to prevent stress incontinence, some have theorized that estrogen may ease irritative symptoms, such as urge and frequency, by acting on estrogen receptors vaginally urethrally and in the trigone.

The disappointing findings on hormone replacement therapy (HRT) echo those from the Heart and Estrogen! Progestin Replacement Study or HERS trial. In a sub-analysis involving 1,525 women with incontinence at baseline, 39% of the women assigned to take conjugated estrogens plus medroxyprogesterone acetate experienced a worsening of ...