Grodstein Francine, Lifford Karen, Resnick Neil M, Curhan Gary C
Channing Laboratory and Renal Division, Department of Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA.
Obstet Gynecol. 2004 Feb;103(2):254-60. doi: 10.1097/01.AOG.0000107290.33034.6f.
To better understand associations between post-menopausal hormone therapy and the development of urinary incontinence.
Postmenopausal hormone use was assessed via biennial mailed questionnaires beginning in 1976 among Nurses' Health Study participants. In 1996, 39,436 post-menopausal women aged 50-75 years reported no leaking of urine and were followed-up for 4 years to identify incident cases of incontinence. We used logistic regression to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relation of postmenopausal hormone use from 1976 to 1996 to the development of incontinence from 1996 to 2000.
We identified 5,060 incident cases of occasional (leaking urine 1-3 times/month) and 2,495 cases of frequent incontinence (leaking at least weekly) for average yearly incidence rates of 3.2% and 1.6%, respectively. The risk of incontinence was elevated among women taking postmenopausal hormones compared with women who had never taken hormones (oral estrogen: RR 1.54, 95% CI 1.44, 1.65; transdermal estrogen: RR 1.68, 95% CI 1.41, 2.00; oral estrogen with progestin: RR 1.34, 95% CI 1.24, 1.44; transdermal estrogen with progestin: RR 1.46, 95% CI 1.16, 1.84). There was little risk after the cessation of hormones (RR 1.14, 95% CI 1.06, 1.23) and a decreasing risk of incontinence with increasing time since last hormone use; 10 years after stopping hormones, the risk was identical in women who had and had never taken hormone therapy (RR 1.02, 95% CI 0.91, 1.14).
Postmenopausal hormone therapy appears to increase risk of developing urinary incontinence. This risk does not vary by route of administration, type of hormones, or dose taken, but is diminished upon cessation of use.
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更好地了解绝经后激素治疗与尿失禁发生之间的关联。
自1976年起，通过每两年邮寄一次问卷的方式，对护士健康研究的参与者进行绝经后激素使用情况评估。1996年，39436名年龄在50至75岁的绝经后女性报告无尿液泄漏，并随访4年以确定尿失禁的新发病例。我们使用逻辑回归来估计1976年至1996年绝经后激素使用与1996年至2000年尿失禁发生之间关系的多变量调整相对风险（RRs）和95%置信区间（CIs）。
我们确定了5060例偶尔尿失禁（每月漏尿1至3次）新发病例和2495例频繁尿失禁（至少每周漏尿一次）新发病例，平均年发病率分别为3.2%和1.6%。与从未使用过激素的女性相比，使用绝经后激素的女性发生尿失禁的风险升高（口服雌激素：RR 1.54，95%CI 1.44，1.65；经皮雌激素：RR 1.68，95%CI 1.41，2.00；口服雌激素加孕激素：RR 1.34，95%CI 1.24，1.44；经皮雌激素加孕激素：RR 1.46，95%CI 1.16，1.84）。激素停用后风险较小（RR 1.14，95%CI 1.06，1.23），且随着末次使用激素时间的增加，尿失禁风险降低；停止使用激素10年后，曾经接受过激素治疗和从未接受过激素治疗的女性风险相同（RR 1.02，95%CI 0.91，1.14）。
绝经后激素治疗似乎会增加发生尿失禁的风险。这种风险不因给药途径、激素类型或服用剂量而有所不同，但在停药后会降低。
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