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December 7, 2005

Estrogen, Progestin, and Urinary Incontinence

JAMA. 2005;294(21):2696-2698. doi:10.1001/jama.294.21.2696-b

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).