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Better evidence for efficacy of postmenopausal incontinence treatments needed

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Urinary symptoms were not significantly improved from local estrogen use in most studies, though an improvement in vaginal symptoms was observed.

Shot of a doctor showing a patient some information on a digital tablet | Image Credit: © bongkarn - stock.adobe.com

A decreased association was observed between systemic estrogen use and the risk of urinary incontinence among postmenopausal women vs placebo, with an OR of 0.74.

Evidence is lacking for effective postmenopausal urinary incontinence treatment, according to a study presented at the 2024 American Urological Association Annual Meeting in San Antonio, Texas.1

Among postmenopausal women, urinary incontinence is often treated using estrogens, anticholinergics, and pelvic floor muscle training. However, the heterogeneity of adopted protocols makes it difficult to compare the efficacy of these treatment methods.

To compare treatment of postmenopausal women with urge incontinence, investigators conducted a systematic review and meta-analysis. Randomized controlled trials (RCTs) were identified through searches of the PubMed and EMBASE databases.

Random effect Mantel-Haenszel statistics were used to measure odds ratios (ORs) for improving urinary incontinence. The final analysis included 35 eligible RTCs, all of which received risk of bias evaluation.

Takeaways

  1. Estrogen use, whether systemic or local, shows limited efficacy in improving postmenopausal urinary incontinence, with systemic estrogen displaying a slight decrease in risk compared to placebo.
  2. Vitamin D, phytoestrogens, and estrogen modulators do not significantly improve urinary symptoms in postmenopausal women.
  3. Oxybutynin demonstrates promise in alleviating urgency and urge incontinence symptoms among postmenopausal women, suggesting its potential as a targeted treatment option.
  4. Combination therapy of anticholinergics and local estrogens does not show increased efficacy in improving urinary incontinence symptoms compared to anticholinergics alone.
  5. Physical therapy emerges as a promising avenue for improving postmenopausal urinary incontinence outcomes, though further high-quality randomized controlled trials are required to validate its effectiveness definitively.

A decreased association was observed between systemic estrogen use and the risk of urinary incontinence among postmenopausal women vs placebo, with an OR of 0.74. However, urinary symptoms were not significantly improved from local estrogen use in most studies, though an improvement in vaginal symptoms was observed.

Neither incontinence symptoms nor other symptoms of genitourinary menopause syndrome were improved by utilization of vitamin D, phytoestrogens, and estrogen modulators, nor were contradictory results observed. In 1 RCT, postmenopausal urgency and urge incontinence were significantly improved by oxybutynin vs placebo.

Data has not indicated increased efficacy from a combination of anticholinergics and local estrogens for improving urinary incontinence symptoms when compared to anticholinergics alone. Overall, physical therapy has been associated with improved outcomes, but this evidence needs further evaluation through quality RCTs.

These results indicated a lack of evidence about effective postmenopausal urinary incontinence treatment. Investigators recommended well-designed large studies with subjective and objective improvement primary endpoints to improve this research gap.

REFERENCE

1. Gherabi N, Trinchieri A, Buchholz N. Treatment of urge incontinence in postmenopausal women: A systematic review. J Urol. 2024;211(55):e389. doi:10.1097/01.JU.0001008776.99097.8a.19

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