Wednesday, February 23, 2005

WHI Strikes Again, A RCT trumps a systematic review and we learn estrogen does not help urinary incontinence

Once again we see a RCT provide a conclusion opposite to that supplied by a systematic review even one done by the legendary Cochrane Group. A 2003 Cochrane review (Moehrer B ,Jextall A, Jackson S, Oestrogens for urinary incontinence in women. Cochrane Data Base Sys rev.2003:(2) CD001405) concluded that oral estrogen treatment could improve or cure incontinence but ,of course, in appropriately cautious tones, recommended further study.
The further study is found in the February 23, 2005 issue of JAMA. Data from the Women's Health Initiative (WHI) showed that estrogen alone and estrogen plus MPA increased the risk of urinary incontinence in continent women and worsened the incontinence in symptomatic women after one year. In a related editorial Dr. Catherine DuBeau attempts to unravel the knotty aspects of biological plausibility and the ins and outs of methodological issues involved in part to try and understand why oral estrogen would worsen incontinence and why progestin seemed to mitigate the effect of estrogen on urge incontinence in the WHI data. The relative risks, though statistically significant,were generally less than 2 and maybe the play of chance is at work in some of the subgroup data. But the bottom line is doctors will likely not be prescribing oral estrogen for urinary incontinence after reading the WHI paper. We await further investigation on the use of topical estrogen.

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