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Factors Associated With Worsening and Improving Urinary Incontinence Across the Menopausal Transition

From the Departments of ¹Obstetrics and Gynecology and ²Statistics, University of California, Davis, California; ³Department of Statistics, University of California, Irvine, California; ⁴Department of Medicine, Geffen School of Medicine at University of California, Los Angeles, California; ⁵School of Nursing, University of Michigan, Ann Arbor, Michigan; ⁷Kaiser Permanente Department of Research, Oakland, California; ⁸Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Division of Epidemiology, Department of Public Health Sciences, University of California, Davis, California.

OBJECTIVE: To evaluate whether the menopausal transition is associated with worsening of urinary incontinence symptoms over 6 years in midlife women.

METHODS: We analyzed data from 2,415 women who reported monthly or more incontinence in self-administered questionnaires at baseline and during the first six annual follow-up visits (1995–2002) of the prospective cohort Study of Women’s Health Across the Nation. We defined worsening as a reported increase and improving as a reported decrease in frequency of incontinence between annual visits. We classified the menopausal status of women not taking hormone therapy annually from reported menstrual bleeding patterns and hormone therapy use by interviewer questionnaire. We used generalized estimating equations methodology to evaluate factors associated with improving and worsening incontinence from year to year.

RESULTS: Over 6 years, 14.7% of incontinent women reported worsening, 32.4% reported improvement, and 52.9% reported no change in the frequency of incontinence symptoms. Compared with premenopause, perimenopause and postmenopause were not associated with worsening incontinence; for example, early perimenopause was associated with improvement (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.06–1.35) and postmenopause reduced odds of worsening (OR 0.80; 95% CI 0.66–0.95). Meanwhile, each pound of weight gain increased odds of worsening (OR 1.04; 95% CI 1.03–1.05) and reduced odds of improving (OR 0.97; 95% CI 0.96–0.98) incontinence.

CONCLUSION: In midlife incontinent women, worsening of incontinence symptoms was not attributable to the menopausal transition. Modifiable factors such as weight gain account for worsening of incontinence during this life stage.

LEVEL OF EVIDENCE: II

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				No Evidence of Worsening Urinary Incontinence During Menopausal Transition Journal Watch (General), May 6, 2008; 2008(506): 3 - 3. [Full Text]