Urinary incontinence is a common problem among postmenopausal women, including 64% of the 25,597 women in the Women's Health Initiative (WHI) study for whom baseline urinary continence data were available. Hormone replacement therapy, which has come under fire in the past couple of years, has long been prescribed for the treatment of urinary incontinence in post-menopausal women-so in addition to studying the effects of hormone therapy (either estrogen or estrogen plus progesterone) on cardiovascular disease and other health problems, the WHI collected data on its effects on incontinence.

Unfortunately, after one year of hormone therapy, there were more new cases of stress, urge, and mixed urinary incontinence among women taking either hormone regimen than among women taking placebo, with the highest incidence among women taking estrogen only. And women taking hormones who had reported incontinence at baseline, especially those taking estrogen alone, experienced greater intensification of symptoms (the frequency of leakage, the volume of urine leaked, the extent to which their incontinence bothered them and limited their activities) at one year than did those taking placebo.

In other words, the therapy believed to be preventing and treating urinary incontinence in postmenopausal women was actually increasing its symptoms, the associated disability, and the onset of new cases. To find effective treatment, the authors recommend further research. Controlled trials are needed to determine whether other preparations of estrogen and progesterone have comparable adverse effects on bladder control in postmenopausal women. -Fran Mennick, BSN, RN

Hendrix SL, et al. JAMA 2005;293(8):935-48.