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Serum estradiol levels are not associated with urinary incontinence in midlife women transitioning through menopause

Waetjen, L. Elaine MD1; Johnson, Wesley O. PhD2; Xing, Guibo PhD1; Feng, Wen-Ying PhD3; Greendale, Gail A. MD4; Gold, Ellen B. PhD5; for the Study of Women’s Health Across the Nation (SWAN)

doi: 10.1097/gme.0b013e31821f5d25
Original Studies
Editorial

Objective: We evaluated the relationship between annually measured serum endogenous estradiol and the development or worsening of stress and urge incontinence symptoms during a period of 8 years in women transitioning through menopause.

Methods: This is a longitudinal analysis of women with incontinence in the Study of Women’s Health Across the Nation, a multicenter, multiracial/ethnic prospective cohort study of community-dwelling women transitioning through menopause. At baseline and at each of the eight annual visits, the Study of Women’s Health Across the Nation elicited the frequency and type of incontinence using a self-administered questionnaire and drew a blood sample on days 2 to 5 of the menstrual cycle. All endocrine assays were performed using a double-antibody chemiluminescent immunoassay. We analyzed the data using discrete Cox survival models and generalized estimating equations with time-dependent covariates.

Results: Estradiol levels drawn at either the annual visit concurrent with or previous to the first report of incontinence were not associated with the development of any (hazard ratio, 0.99; 95% CI, 0.99-1.01), stress, or urge incontinence in previously continent women. Similarly, estradiol levels were not associated with the worsening of any (odds ratio, 1.00; 95% CI, 0.99-1.01), stress, or urge incontinence in incontinent women. The change in estradiol levels from one year to the next was also not associated with the development (hazard ratio, 0.98; 95% CI, 0.97-1.00) or worsening (odds ratio, 1.03; 95% CI, 0.99-1.05) of incontinence.

Conclusions: We found that annually measured values and year-to-year changes in endogenous estradiol levels had no effect on the development or worsening of incontinence in women transitioning through menopause.

From the 1Department of Obstetrics and Gynecology, University of California, Davis, CA; 2Department of Statistics, University of California, Irvine, CA; 3Department of Statistics, University of California, Davis, CA; 4Department of Medicine, Geffen School of Medicine at University of California, Los Angeles, CA; and 5Division of Epidemiology, Department of Public Health Sciences, University of California, Davis, CA.

Received February 22, 2011; revised and accepted April 12, 2011.

Funding/support: The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), Department of Health and Human Services (DHHS), through the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health (ORWH; Grants NR004061 and AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, and AG012495). Work on this article was also supported by Grant AG027056 to L. Elaine Waetjen. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.

Financial disclosures/conflicts of interest: None reported.

No reprints will be available.

Address correspondence to: L. Elaine Waetjen, MD, Department of Obstetrics and Gynecology, 4860 Y Street, Suite 2500, Sacramento, CA 95817. E-mail: lewaetjen@ucdavis.edu

©2011The North American Menopause Society