Meta-analysis Of The Effects Of Menopausal Hormone Therapy On Female Urinary Incontinence

Background:Urinary incontinence(UI)is the complaint of involuntary loss(leakage)of urine when the abdominal pressure is increased.The epidemiological survey conducted in China shows that the prevalence of SUI among women aged 50-59 years is the highest,reaching 28.0%.The occurrence of urinary incontinence has seriously affected the quality of life of women.The decrease in estrogen in postmenopausal women can cause atrophy of the lower urinary tract,causing a series of symptoms of lower urinary tract such as urinary incontinence,frequent urination,urgency,and repeated urinary tract infections.At present,the effect of menopausal hormone therapy(MHT)on female urinary incontinence(UI)is controversial.Objective:We performed a meta analysis of the available evidence,in order to evaluation the effect of hormone on urinary incontinence.Methods:An overall literature search was conducted.Randomized controlled trials(RCT)of all menopausal hormone therapy and urinary incontinence in postmenopausal women were collected by computer on PubMed,Embase,The Cochrane Library,Web of science,China Knowledge Network(CNKI)5 WanFang,and WeiPu search engines.And the languages were restricted to Chinese and English.Trials were collected according to the inclusion and exclusion criteria.Two authors to identify randomized controlled clinical trials,which compared MHT and placebo for treatment of urinary incontinence.Meta-analysis of the clinical efficacy was conducted with The Cochrane Collaboration's RevMan 5.3 software.Results:A total of 12 trials were met the inclusion criteria,including 30,544 females.Of those women included in the analysis,15,401 were in the MHT group and15,143 in the placebo group.Meta-analysis results showed that compared MHT with placebo.(1)For non-UI women after menopause,the prevalence of UI with MHT was much higher than with placebo[OR=1.65,95%Cl(1.53,1.77),Z=13.20,P<0.00001].(2)For postmenopausal women with UI,the rate of non-improvement of UI after MHT was much higher than those with placebo[OR=1.59,95%CI(1.35,1.87),Z=5.55,P<0.00001].(3)For postmenopausal women with UI,the rate of non-improvement of UUI after MHT was much higher than those with placebo[OR=1.61,95%CI(1.29,2.02),Z=4.16,P<0.0001].(4)For postmenopausal women with UI,the rate of non-improvement of SUI with oral hormonal treatment was much higher than those with placebo[OR=1.86,95%CI(1.50,2.31),Z=5.64,P<0.0001].(5)For postmenopausal women with UI,the rate of non-improvement of SUI with local hormonal treatment was much lower than those with placebo[OR=0.20,95%CI(0.09,0.48),P=0.0003].(6)For postmenopausal women with UI.There was no difference in changes in maximum cystometric capacity(MCC),maximum urethral closure pressure(MUCP),and 24-hour objective urine leakage.Conclusion:Oral hormonal treatment increases the incidence of urinary incontinence in postmenopausal women without urinary incontinence.For postmenopausal women with urinary incontinence,long-term oral estrogen may aggravate the symptoms of urinary incontinence,but local hormonal treatment may improve the symptoms of urinary incontinence.Other aspects,MHT have no significant effect on maximum cystometric capacity,maximum urethral closure pressure,and 24-hour objective urine leakage.