To the Editor: The study of the effects of estrogen with and without progestin on urinary incontinence by Dr Hendrix and colleagues1 includes a number of methodological limitations that prevent reaching the conclusion that this treatment should not be prescribed for the prevention or relief of urinary incontinence.
This conclusion is based on a questionnaire administered to participants of both the estrogen/progestin and estrogen only arm of the Women's Health Initiative (WHI). It appears that none of these women was evaluated by a urogynecologist or urologist, or underwent urodynamic testing to accurately assess their incontinence. No information is given about gynecological comorbidity such as endometriosis, uterine fibroids, or interstitial cystitis; the number of women in either the control or treatment groups who had undergone urological procedures including urethral dilation or major reconstruction of the pelvic support system; or whether women receiving hormones may have become more sexually active, which would put them at risk for urinary tract infections (a common cause of incontinence).
Estrogen, Progestin, and Urinary Incontinence. JAMA. 2005;294(21):2696-2698. doi:10.1001/jama.294.21.2696-b