Estrogen Therapy in the Management of Urinary Incontinence in Postmenopausal Women: A Meta-Analysis. First Report of the Hormones and Urogenital Therapy Committee

Objective: To apply a meta-analysis to available data to evaluate the efficacy of estrogen therapy in the management of postmenopausal women with urinary incontinence. Methods: The literature review incorporated English language articles based on a search of EXCERPTA MEDICA, BIOSIS, and MEDLINE from January 1969 to June 1992. Criteria included: peer-reviewed original article, confirmed diagnosis of urinary incontinence, an estrogen-treated group, and outcome data on subjective improvement, quantitation of fluid loss, or maximum urethral closure pressure. In addition, the data had to allow comparison between treated and control groups in controlled trials or an estimated change in uncontrolled series. Meta-analytic methods were applied only to studies considered to be controlled clinical trials. Results: Of 166 articles reviewed, 143 did not meet the entry criteria; six were considered controlled clinical trials and 17 were uncontrolled series. Meta-analysis found an overall significant effect of estrogen therapy on subjective improvement for all subjects (P<.01) and for subjects with genuine stress incontinence alone (P<.05). The results showed no significant effect on quantity of fluid loss but a significant effect (P<.05) on maximum urethral closure pressure. However, the latter result was influenced by only one study showing a large effect. Conclusion: It appears from this analysis that estrogen subjectively improves urinary incontinence in postmenopausal women. However, the studies included nonhomogeneous groups, and the diagnostic criteria, therapeutic interventions, and outcome assessments varied considerably.