Skip to main content
Top
Published in: Current Bladder Dysfunction Reports 4/2019

01-12-2019 | Stress Incontinence | Stress Incontinence and Prolapse (WS Reynolds, Section Editor)

Hormone Replacement for Pelvic Floor Disorders

Authors: Joseph Panza, W. Stuart Reynolds

Published in: Current Bladder Dysfunction Reports | Issue 4/2019

Login to get access

Abstract

Purpose of Review

The purpose of this review article is to summarize the recent literature regarding the effect of hormone replacement therapy on pelvic floor disorders and its role as a preventative or treatment option.

Recent Findings

The recent evidence describing the effect of hormone replacement therapy on pelvic floor disorders is mainly limited to cohort studies, systematic reviews, and secondary analysis of randomized controlled trials such as the Women’s Health Initiative and Nurses’ Health Study. There are few quality randomized controlled trials, especially within the last 5 years on this topic. The data that does exist does not show hormone therapy to be beneficial in the treatment or prevention of pelvic floor disorders. In fact, it may worsen urinary and fecal incontinence when given systemically. The exception to this is the local application of vagina estrogen, where it may be of some benefit in the treatment of urinary incontinence. Local application has been shown to be beneficial when treating genitourinary syndrome of menopause and in the prevention of recurrent urinary tract infections.

Summary

There is a paucity of quality data regarding the secondary effects and use of hormone replacement as a treatment for pelvic floor disorders. Given the lack of studies, limited efficacy, and possible side effects, it should not be offered as first-line or single treatment for pelvic floor disorders such as urinary or fecal incontinence and pelvic organ prolapse. It may be used as a treatment for genitourinary syndrome of menopause and for prevention of urinary tract infections when placed locally in the vagina.
Literature
4.
go back to reference • ACOG Practice Bulletin No 141. Management of menopausal symptoms. 2018; 1–15. This reference is of importance as it provides evidence-based guidelines on the treatment of menopausal symptoms (including vagina symptoms) as supported by the American College of Obstetrics and Gynecology. It has a large amount of information on hormone therapies, their routes of administration, and side effects. • ACOG Practice Bulletin No 141. Management of menopausal symptoms. 2018; 1–15. This reference is of importance as it provides evidence-based guidelines on the treatment of menopausal symptoms (including vagina symptoms) as supported by the American College of Obstetrics and Gynecology. It has a large amount of information on hormone therapies, their routes of administration, and side effects.
5.
go back to reference Smith P. Estrogens and the urogenital tract. Acta Obstet Gynecol Scand Suppl. 1993;157:1–26.PubMed Smith P. Estrogens and the urogenital tract. Acta Obstet Gynecol Scand Suppl. 1993;157:1–26.PubMed
7.
go back to reference Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev. 2012;30(1):37–86. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev. 2012;30(1):37–86.
8.
go back to reference McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14:103–15.CrossRef McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14:103–15.CrossRef
9.
go back to reference Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Julia MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52(Suppl 1):S46–52.CrossRef Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Julia MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52(Suppl 1):S46–52.CrossRef
12.
go back to reference Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103–11.CrossRef Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103–11.CrossRef
16.
go back to reference American College of Obstetricians and Gynecologists. Urinary incontinence in women. Practice Bulletin No. 155. Obstetetics and Gynecology. 2018;126:e66–81. American College of Obstetricians and Gynecologists. Urinary incontinence in women. Practice Bulletin No. 155. Obstetetics and Gynecology. 2018;126:e66–81.
17.
go back to reference •• Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA. 2005;293(8):935–48 This reference is of importance given its large, varied patient population and though it is a secondary analysis, the original study was a multicenter double-blind, placebo-controlled, randomized clinical trial. CrossRef •• Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA. 2005;293(8):935–48 This reference is of importance given its large, varied patient population and though it is a secondary analysis, the original study was a multicenter double-blind, placebo-controlled, randomized clinical trial. CrossRef
18.
go back to reference Grodstein F, Lifford K, Resnick NM, Curhan GC. Postmenopausal hormone therapy and risk of developing urinary incontinence. Obstet Gynecol. 2004;103:254–60.CrossRef Grodstein F, Lifford K, Resnick NM, Curhan GC. Postmenopausal hormone therapy and risk of developing urinary incontinence. Obstet Gynecol. 2004;103:254–60.CrossRef
19.
go back to reference Steinauer JE, Waetjen LE, Vittinghoff E, et al. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol. 2005;106:940–5.CrossRef Steinauer JE, Waetjen LE, Vittinghoff E, et al. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol. 2005;106:940–5.CrossRef
20.
go back to reference Jackson S, James M, Abrams R. The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence. BJOG. 2002;109(3):339–44.CrossRef Jackson S, James M, Abrams R. The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence. BJOG. 2002;109(3):339–44.CrossRef
21.
go back to reference Capobianco G, Donolo E, Borghero G, Dessole F, Cherchi PL, Dessole S. Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women. Arch Gynecol Obstet. 2011;285(2):397–403.CrossRef Capobianco G, Donolo E, Borghero G, Dessole F, Cherchi PL, Dessole S. Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women. Arch Gynecol Obstet. 2011;285(2):397–403.CrossRef
22.
go back to reference Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.CrossRef Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.CrossRef
23.
go back to reference Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.CrossRef Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.CrossRef
25.
go back to reference Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev. 2010;15(2):241–35. Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev. 2010;15(2):241–35.
30.
go back to reference Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. Am J Gastroenterol. Nature Publishing Group. 2014;110(1):127–36.CrossRef Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. Am J Gastroenterol. Nature Publishing Group. 2014;110(1):127–36.CrossRef
31.
go back to reference Bharucha AE, Zinsmeister AR, Locke GR, et al. Risk factors for fecal incontinence: a population-based study in women. Am J Gastroenterol. 2006;101:1305–12.CrossRef Bharucha AE, Zinsmeister AR, Locke GR, et al. Risk factors for fecal incontinence: a population-based study in women. Am J Gastroenterol. 2006;101:1305–12.CrossRef
32.
go back to reference Goode PS, Burgio KL, Halli AD, et al. Prevalence and correlates of fecal incontinence in community-dwelling older adults. J Am Geriatr Soc. 2005;53:629–35.CrossRef Goode PS, Burgio KL, Halli AD, et al. Prevalence and correlates of fecal incontinence in community-dwelling older adults. J Am Geriatr Soc. 2005;53:629–35.CrossRef
33.
go back to reference • Staller K, Townsend MK, Khalili H, Mehta R, Grodstein F, Whitehead WE, et al. Menopausal hormone therapy is associated with increased risk of fecal incontinence in women after menopause. Gastroenterology. 2017;152(8):1915–1921.e1. https://doi.org/10.1053/j.gastro.2017.02.005Given the mixed results from prior studies on fecal incontinence and its association with hormone therapy use, this reference is important because of its large patient population and clear link between HRT and fecal incontinence use. CrossRefPubMedPubMedCentral • Staller K, Townsend MK, Khalili H, Mehta R, Grodstein F, Whitehead WE, et al. Menopausal hormone therapy is associated with increased risk of fecal incontinence in women after menopause. Gastroenterology. 2017;152(8):1915–1921.e1. https://​doi.​org/​10.​1053/​j.​gastro.​2017.​02.​005Given the mixed results from prior studies on fecal incontinence and its association with hormone therapy use, this reference is important because of its large patient population and clear link between HRT and fecal incontinence use. CrossRefPubMedPubMedCentral
34.
go back to reference Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–6.CrossRef Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–6.CrossRef
35.
go back to reference Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol. 1999;180(5):1072–9.CrossRef Eriksen B. A randomized, open, parallel-group study on the preventive effect of an estradiol-releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women. Am J Obstet Gynecol. 1999;180(5):1072–9.CrossRef
37.
go back to reference Anger J, et al. American Urologic Association. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. 2019:1–36. Anger J, et al. American Urologic Association. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. 2019:1–36.
38.
go back to reference Raz R. Urinary tract infection in postmenopausal women. Korean J Urol. 2011;52(12):801–8.CrossRef Raz R. Urinary tract infection in postmenopausal women. Korean J Urol. 2011;52(12):801–8.CrossRef
40.
43.
go back to reference American College of Obstetricians and Gynecologists. Management of gynecologic issues in women with breast cancer. Practice Bulletin No. 126. Obstetetics and Gyencology. 2012; 119:666–82. American College of Obstetricians and Gynecologists. Management of gynecologic issues in women with breast cancer. Practice Bulletin No. 126. Obstetetics and Gyencology. 2012; 119:666–82.
44.
go back to reference Bachmann GA, Leiblum SR. The impact of hormones on menopausal sexuality: a literature review. Menopause. 2004;11(1):120–30.CrossRef Bachmann GA, Leiblum SR. The impact of hormones on menopausal sexuality: a literature review. Menopause. 2004;11(1):120–30.CrossRef
45.
go back to reference Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas. 1996;23:259–63.CrossRef Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas. 1996;23:259–63.CrossRef
47.
go back to reference Thompson LU, Boucher BA, Liu Z, et al. Phytoestrogen content of foods consumed in Canada, including isoflavones, lignans, and coumestan. Nutr Cancer. 2006;54(2):184–201.CrossRef Thompson LU, Boucher BA, Liu Z, et al. Phytoestrogen content of foods consumed in Canada, including isoflavones, lignans, and coumestan. Nutr Cancer. 2006;54(2):184–201.CrossRef
48.
go back to reference Kuiper GG, Lemmen JG, Carlsson B, et al. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology. 1998;139(10):4252–63.CrossRef Kuiper GG, Lemmen JG, Carlsson B, et al. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology. 1998;139(10):4252–63.CrossRef
49.
go back to reference Tomaszewski J, Adamiak A, Skorupski P, et al. Effect of 17 beta-estradiol and phytoestrogen daidzein on the proliferation of pubocervical fascia and skin fibroblasts derived from women suffering from stress urinary incontinence. Ginekol Pol. 2003;74(10):1410–4.PubMed Tomaszewski J, Adamiak A, Skorupski P, et al. Effect of 17 beta-estradiol and phytoestrogen daidzein on the proliferation of pubocervical fascia and skin fibroblasts derived from women suffering from stress urinary incontinence. Ginekol Pol. 2003;74(10):1410–4.PubMed
50.
go back to reference Owen SJ, Rose’Meyer RB, Massa HM. Dietary phytoestrogens maintain contractile responses to carbachol with age in the female rat isolated bladder. Life Sci. 2011;89(7–8):213–20.CrossRef Owen SJ, Rose’Meyer RB, Massa HM. Dietary phytoestrogens maintain contractile responses to carbachol with age in the female rat isolated bladder. Life Sci. 2011;89(7–8):213–20.CrossRef
Metadata
Title
Hormone Replacement for Pelvic Floor Disorders
Authors
Joseph Panza
W. Stuart Reynolds
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 4/2019
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-019-00536-5

Other articles of this Issue 4/2019

Current Bladder Dysfunction Reports 4/2019 Go to the issue

Pharmacotherapies and Drug Development/Agents (ES Rovner, Section Editor)

Advances in Pharmacotherapy for the Treatment of Overactive Bladder

Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)

Consequences of Pelvic Radiotherapy on Urinary Function in Women

Pharmacotherapies and Drug Development/Agents (ES Rovner, Section Editor)

Pharmacotherapy for Interstitial Cystitis/Bladder Pain Syndrome

Overactive Bladder (U Lee and S Adelstein, Section Editors)

Is Vaginal Laser Effective for Overactive Bladder? Results of a Systematic Review

Overactive Bladder (U Lee and S Adelstein, Section Editors)

Overactive Bladder in Diabetes Mellitus

Cancer-Associated Voiding Dysfunction (S Elliott and J Pariser, Section Editor)

Rectourethral Fistula—Review of Current Practices, Developments, and Outcomes