Study suggests that various types of hormone therapy are effective in reducing the number of times during the night that postmenopausal women are woken up by the need to urinate
As women age, they are more likely to wake up in the middle of the night to pass urine. The loss of estrogen during the menopause transition accelerates this problem, which is known as nocturia. A new study evaluated the effectiveness of different hormone therapies in managing the frequency of nocturia. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).
The loss of estrogen during menopause has been shown to create bladder dysfunction, sleep disorders, hot flashes, and alterations in renal water and salt handling, all of which result in higher diuresis overnight. To date, there has been little research done regarding the effect of hormone therapy on nocturia, even though hormone therapy has been proven to improve the causative factors of postmenopausal nocturia such as sleep disorders, obstructive sleep apnea, and hot flashes.
Vaginal estrogen has already been shown to help manage the various symptoms of the genitourinary syndrome of menopause, especially with regard to improving urinary function. However, little was known about the effect of systemic treatment. In addition, there is some limited evidence suggesting significant benefits of using oral estrogen in combination with oral progesterone, but nothing is known about the effects of other hormone combinations or the newer tissue-selective estrogen complex (TSEC) on nocturia.
In this new study involving nearly 250 women, participants were divided into four treatment groups: estrogen and progesterone (E+P); estrogen only in patients with prior hysterectomies; TSEC; and no treatment. The study concluded that systemic treatment with either E+P or TSEC led to a significant reduction in nocturia prevalence and significant improvement of bothersome symptoms in women with two or more nocturnal voids. The use of estrogen only resulted in a significant reduction in urgency prevalence.
Researchers believe that additional research should be conducted to better understand the underlying pathophysiologic triggers.
Objective: To observe the impact of different hormonal treatment options on nocturia, its causative factors and bother in postmenopausal women.
Methods: This prospective study recruited 245 postmenopausal women and divided them into four treatment groups based on patient's choice: Estrogen + Progesterone (E+P), Estrogen-only in patients with a prior hysterectomy, tissue-selective estrogen complex (TSEC) and no treatment. Nocturia and its causative factors were observed using two standardized questionnaires before and after treatment: the International Consultation on Incontinence Questionnaire Nocturia Module and the Targeting the individual's Aetiology of Nocturia to Guide Outcomes (TANGO). The results of the Targeting the individual's Aetiology of Nocturia to Guide Outcomes were divided in four influencing topics of which the sum score was calculated.
Results: A significant reduction in prevalence of nocturia ≥ twice per night was seen after treatment, as the prevalence decreased from 27.7% (59/213) to 16.4% (35/213). Specified per therapy, a significant reduction in nocturnal voiding frequency was observed in patients treated with E+P and TSEC (P = 0.018 and P = 0.018, respectively). This improvement could be explained by a significant reduction in SLEEP sum score in patients treated with E+P and TSEC (P < 0.001, P = 0.013, respectively). Estrogen-only led to a significant change in URINARY TRACT sum score, which is the result of a reduction in urgency prevalence (P = 0.039).
Conclusions: E+P and TSEC treatment led to a significant reduction in nocturia prevalence and bother in women with ≥ 2 nocturnal voids. This effect is mainly the result of improvement in sleep disorders, however an improvement in bladder disorders can be suggested as well. More research is necessary to confirm these findings.
Kim Pauwaert, An-Sofie Goessaert, Lynn Ghijselings, Wendy Bower, An Mariman, Dirk Vogelaers, Herman Depypere, Karel Everaert. Menopause 2021 Mar 15. doi: 10.1097/GME.0000000000001741. Online ahead of print. Hormone therapy as a possible solution for postmenopausal women with nocturia: results of a pilot trial