Aims of study:

The menopause and oestrogen deficiency have been implicated in the aetiology of urinary symptoms. However the role of oestrogen replacement in the treatment of urinary symptoms is questionable. We have sought to investigate the association between menopausal status and use of hormone replacement therapy with urinary symptoms in a community sample.

 

Methods:

A postal questionnaire was sent to 18,007 women aged 40 to 69 selected at random from a community population. The questionnaire asked about menopausal status, prior hysterectomy, use of hormone replacement therapy (HRT), urinary symptoms (including incontinence) and demographic variables. Analysis was performed using logistic regression in SPSS.

 

Results:

There were 11,776 questionnaires returned (67%). Of respondents 16% had had a hysterectomy. The last menstrual period of the remainder was: within the last 3 months 36.5%, 3-11 months 3.7%, 1-5 years 10.6% and more than five years ago 33.1%. HRT was used by 18% of the women. Urinary symptoms tended to be more common in women who were post menopausal and in women taking HRT. After adjusting for age the only symptom more commonly reported after the menopause was nocturia (OR=1.46, p=0.01) and stress incontinence was less commonly reported (OR=0.75, p=0.0005). Urinary symptoms continued to be associated with HRT usage after adjusting for confounding variables.

 

Conclusions:  There does not seem to be a significant beneficial association between urinary symptoms and higher oestrogen status. Recommendations for the use of oestrogen supplementation in the management of urinary symptoms are questionable. Further evidence is needed in the form of randomised controlled trials before the efficacy of such treatment can be ascertained. We are presently conducting such a trial in community dwelling women receiving primary care for urinary symptoms.