Can estrogen therapy make urinary incontinence worse?

Estrogen is sometimes prescribed as an oral pill or vaginal supplement to improve the strength of tissues in the urinary tract of women who show signs of deficiency. However, in the large multicenter trial known as the Women's Health Initiative, oral conjugated equine estrogen (Premarin), both alone and combined with a progestin (as Prempro, the most commonly prescribed formulation), worsened stress incontinence (leaking when coughing or jumping) and overactive bladder (frequent urination and urges to urinate) in postmenopausal women who already had incontinence, and increased the risk that incontinence would develop in women who were continent at the beginning of the study. Few studies demonstrate any benefit of vaginal estrogen therapy in treating incontinence. But in one Italian study, women who received vaginal estrogen after a sling procedure developed fewer symptoms of overactive bladder after surgery than those who received no estrogen. Many surgeons prescribe topical estrogen to promote healing after surgery.

Hormone therapy is generally recommended only for the short-term treatment of menopausal symptoms. However, using vaginal estrogen cream or suppositories one to three times a week is probably safe over the long term because the estrogen does not enter the bloodstream in significant amounts.

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