Vaginal estrogen for treatment of urinary symptoms

Article

In a recent review, vaginal estrogen was effective for treating urinary symptoms in postmenopausal women.

Vaginal estrogen for treatment of urinary symptoms | Image Credit: © Zerbor - © Zerbor - stock.adobe.com.

Vaginal estrogen for treatment of urinary symptoms | Image Credit: © Zerbor - © Zerbor - stock.adobe.com.

According to a recent study published in Menopause, improvements in urinary symptoms and decreased risk of recurrent urinary tract infections (UTI) are accomplished through vaginal estrogen.

Genitourinary syndrome of menopause (GSM) refers to vulvovaginal changes experienced after menopause. Symptoms of GSM include urinary urgency, frequency, dysuria, and recurrent UTIs. Treatment recommendations were updated in 2020 to include vaginal estrogen.

It is important to understand the link between menopause and GSM symptoms, as urinary symptoms are highly prevalent. A link between menopause and urinary symptoms may indicate hormone therapy (HT) could be used for treatment.

To determine the association between menopause and certain urinary symptoms, investigators conducted a systematic review. Symptoms evaluated included dysuria, urgency and frequency, recurrent UTIs, and urinary incontinence.

Studies reviewed included randomized control trials (RCTs) with perimenopausal and postmenopausal women, evaluating urinary symptoms as a primary or secondary outcome. RCTs were written in English and had at least 1 arm of estrogen therapy.

Animal trials, pilot studies secondary analyses, pharmacokinetic studies, cancer studies, position papers, observational studies, and conference abstracts were excluded. Databases searched included Pubmed, Scopus, and the Cochrane Central Register of Controlled Trials. Searches lasted until October 2020.

Search terms were related to menopause, urinary symptoms, and UTIs. Five authors reviewed articles, with data extracted including country of origin, publication date, number of participants, setting, duration, follow-up, mean age of participants, inclusion of race and ethnicity data, inclusion and exclusion criteria, design, outcomes, and main findings.

The Jadad scoring system was used to rate RCTs on their methodological quality. Criteria used to score RCTs included the trial being randomized, using an appropriate randomization method, being blinded, using an appropriate blinding method, and accounting for all randomized participants.

There were 30 RCTs included in the analysis, published from 1978 to 2021 and including data from 17 countries. Only RCTs evaluating the impact of HT on urinary symptoms were included. Based on the Jadad scoring system, 13 of the 30 trials were of medium to high quality.

Statistically significant improvements from oral estrogen were only recorded in a single RCT from 1978, with no other trials indicating improvements from systemic HT. A large RCT known as the Women’s Health Initiative found increased stress incontinence from estrogen only and combined oral HT.

Urinary symptoms were also not improved through subcutaneous estrogen or transdermal estrogen. Data comparing oral estrogen and vaginal estrogen, raloxifene, transdermal estrogen, and oral isoflavone was inconsistent, making it difficult to draw a conclusion.

When evaluating the effects of vaginal estrogen formulations, most RCTs reviewed found statistically significant improvements in urinary symptoms such as dysuria, urinary frequency, stress and urge incontinence, and recurrent UTI reductions.

Overall, there was no conclusive data on the association between menopause and urinary symptoms. However, vaginal estrogen proved effective at treating urinary symptoms and recurrent UTI. Investigators recommended postmenopausal women with urinary symptoms consider vaginal estrogen for treatment.

Reference

Christmas MM, Iyler S, Daisy C, Maristany S, Letko J, Hickey M. Menopause hormone therapy and urinary symptoms: a systematic review. Menopause. 2023;30(6):672-685. doi:10.1097/GME.0000000000002187

Related Videos
One year out: Fezolinetant displays patient satisfaction for managing hot flashes | Image Credit: sutterhealth.org
Unlocking therapeutic strategies for menopausal cognitive decline | Image Credit: uclahealth.org.
Navigating menopause care: Expert insights from ACOG 2024 | Image Credit: mayo.edu.
New data shows elinzanetant's efficacy in treating menopausal symptoms | Image Credit: uvahealth.com
Navigating vasomotor symptoms in breast cancer patients | Image Credit: menopausefoundationcanada.ca.
Revolutionizing menopause management: A deep dive into fezolinetant | Image Credit: uvahealth.com.
Hot flashes poorly impact sleep quality | Image Credit: intimmedicine.com
How to manage bone health in midlife women | Image Credit: - endocrine.org
Mary Jane Minkin, MD, discusses The Menopause Society 2023 Annual Meeting | Image Credit: Yale School of Medicine
Highlights from The Menopause Society 2023 Annual Meeting  | Image Credit: nursebarb.com
Related Content
© 2024 MJH Life Sciences

All rights reserved.