Hormone replacement therapy and the bladder

Lower urinary tract symptoms are a common, distressing and embarrassing problem for women of all ages, but become increasingly more common with advancing age. Oestrogen preparations have been used for many years to manage urinary symptoms, but there is still controversy over the efficacy of these preparations. The purpose of this review is to provide a critical overview of the epidemiological evidence when considering hormone replacement therapy for treatment of urinary symptoms in women. Various studies have demonstrated that oestrogen replacement can improve, or even cure, urinary stress and urge incontinence. High dose oestrogen can reduce the total number of voids in 24 hours, including nocturnal voids. Vaginal oestriol significantly reduces the risk of recurrent infections in postmenopausal women with a history of recurrent urinary tract infections. Data on combining oestrogen with a progestogen are limited, but suggest it may negate the benefit and more research is still required in this area to clarify their role.