Pseudoincontinence secondary to unopposed estrogen replacement in the surgically castrate premenopausal female

Over a four-year period, approximately 200 patients were evaluated for incontinence at the Urogynecology Clinic of the University of Minnesota Hospitals. Seven women between the ages of 26-56 complained of incontinence beginning shortly after hysterectomy-oophorectomy for benign disease. Each gave a history of continuous leakage of urine per vagina. Urodynamics, provocative testing, and home pad tests with urinary dye all failed to prove incontinence. A common historic feature was replacement therapy with unopposed conjugated estrogen. Addition of a progestational agent to the estrogen replacement regimen eliminated the fluid loss per vagina in six of the seven women and improved it in the remaining patient. Unnecessary surgery and evaluation might have been prevented had this condition been recognized earlier.