HRT may lead to bladder-control problems

The risk of urge and stress incontinence increases within a few months of starting estrogen plus progestin hormone replacement therapy (HRT) in postmenopausal women. Women considering HRT should be informed of the increased risks of urge and stress urinary incontinence. More than 40 percent of postmenopausal women suffer from urinary incontinence. In stress incontinence, the bladder tends to leak urine when movement puts pressure on it, during exercise, for example, or when a person laughs or coughs. Urge incontinence is marked by an overwhelming and frequent urge to urinate.Researchers from the University of California at San Francisco used data from the Heart Estrogen/progestin Replacement Study and assessed the occurrence of urinary incontinence in roughly 1,200 women who reported no episodes of incontinence in the week prior to starting HRT or placebo. The subjects were followed for about 4 years.During this time, 64 percent of HRT-treated women reported weekly incontinence compared with 49 percent of those given placebo, a statistically significant difference. This difference was noted at 4 months and persisted for the full study period, independent of age.Treatment with HRT increased the risk of urge and stress incontinence by 50 percent and 70 percent, respectively. The excess risks of weekly urge and stress incontinence attributed to HRT were 12 percent and 16 percent, respectively.The findings supports previous randomized trials suggesting that HRT can either trigger or worsen urinary incontinence in postmenopausal women. Interestingly, these results contradict physiologic data suggesting that HRT might actually improve incontinence.