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A recently published paper by Waetjen and colleagues [1] reports on data derived from the SWAN study of community-dwelling, multi-ethnic, mid-life, American women passing through the menopausal transition. A cohort of 1529 women, free of incontinence at baseline, was followed through six annual follow-up visits with a self-administered questionnaire. During that time, 855 women reported some incontinence, with 433 reporting stress incontinence and 244 urge incontinence. Compared with the premenopause, early perimenopause and late perimenopause were associated with an increased risk of ‘monthly or more frequent’ but not ‘weekly or more frequent’ urinary incontinence: relative risks 1.34 (95% confidence interval (CI) 1.07–1.68) and 1.52 (95% CI 1.12–2.05), respectively. In contrast, postmenopausal women experienced no increased incidence of incontinence.


The conclusions were that the menopausal transition stage might affect only infrequent incontinence symptoms and that modifiable risk factors for incontinence, such as anxiety, weight gain and diabetes, required more attention and the need to emphasize healthy lifestyle choices.


  • Rodney J. Baber
    Associate Professor of Obstetrics and Gynaecology at The University of Sydney, Head, Menopause Unit, The Royal North Shore Hospital of Sydney, New South Wales, Australia


  1. Waetjen LE, Ye J, Feng WY, et al. Association between menopausal transition stages and developing urinary incontinence. Obstet Gynecol 2009;114:989-98.
  2. Waetjen LE, Feng WY, Ye J, et al. Factors associated with worsening and improving urinary incontinence across the menopausal transition. Obstet Gynecol 2008;111:667-77.
  3. Hextall A, Bidmead J, Cardozo L, Hooper R. The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation. Br J Obstet Gynaecol 2001;108:1193-6.
  4. Hendrix SL, Cochrane BB, Nygaard IE, et al. Effects of estrogen with and without progestin on urinary continence. JAMA 2005;293:935-48.
  5. Mishra GD, Hardy R, Cardozo L, Kuh D. Body weight through adult life and risk of urinary incontinence in middle-aged women: results from a British prospective cohort. Int J Obesity 2008;32:1415-22.
  6. Ham E, Choi H, Seo JT, et al. Risk factors for female urinary incontinence among middle-aged Korean women. J Womens Health 2009;18:1801-6.
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