Urinary incontinence estrogens

Vaginally-administered estrogen plays only a modest role in managing stress urinary incontinence (urethral underactivity), unless it is accompanied by local signs of estrogen deficiency (e.g., atrophic urethritis or vaginitis). 

In the past, hypernephroma was thought to result from estrogen treatment. However, there is no clear evidence that this is so. There is evidence that older women with an intact uterus become more susceptible to urinary tract infections by taking estrogens (51). This is surprising, since some other studies, admittedly in selected patients, have shown a reduction in such infections when hormone replacement therapy is used. In another study, hormone replacement therapy improved urinary incontinence and nocturia after 6 months in postmenopausal women, without affecting bacteriuria (52). 

Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, Aragaki A, Naughton MJ, Wallace RB, McNeeley SG, Waetjen LE. Estrogen therapy increased the incidence and severity of urinary incontinence symptoms in postmenopausal women. Evid Based Obstet Gynec 2005 7 149-50. 

Administration of estradiol cypionate (4-10 fig/kg i.m. daily for 3 days then every other day) or estradiol benzoate (10-12 xg/kg using a similar dosing schedule) has been reported to improve urinary incontinence in mares (Watson et al 1997). Estrogen receptors are present in the bladder neck and the hormone appears to modulate the effects of norepinephrine on the a adrenoceptors in the urethral sphincter, thereby improving urethral sphincter tone. However, the doses of... 

Urinary incontinence, which becomes more prevalent with increasing age, usually is not improved by estrogen therapy, and in one large clinical trial, estrogen-progestogen therapy actually increased incontinence. ... 

Kinn A-C, Lindskog M. Estrogens and phenylpropanolamine in combi-nahon for stress urinary incontinence in postmenopausal women. Urology 1988 32 273-280. 

Northington GM, de Vries HF, Bogner HR. Self-reported estrogen use and newly incident urinary incontinence among postmenopausal community-dwelling women. Menopause 2012 19(3) 290-5. 

Duloxetine (when approved for treatment of urinary in- continence), a-adrenergic receptor agonists, and topical (vaginal) estrogens (alone or together) are the therapies of choice in urethral underactivity (stress incontinence). 

Initiated at the onset of menopause, this therapy also has favorable effects on serum cholesterol levels (reduces low-density lipoprotein and elevates high-density lipoprotein levels). Women taking ERT have found relief from hot flashes, vaginal dryness, and urinary stress incontinence (21). It is recommended that the estrogen be combined with a progestin for those women with an intact uterus so as to decrease the risk of... 

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