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Urinary incontinence (UI) is a common and frequently overlooked problem in aging women [1,2]. Leaking urine limits daily and working activities, social interaction and sexual intimacy, and therefore severely disrupts quality of life [3]. The relationship between menopause, aging and hysterectomy is complex and still unresolved. While it is clinically appreciated that all these factors have some impact on the frequency and severity of urinary incontinence, epidemiologic evidence is contradictory and a clear demonstration of how these factors interact in favoring incontinence is not available.

 

Removal of the uterus is one of the most frequent surgical procedures performed in women, and appropriate counseling related to future risks, particularly that of UI or pelvic organ prolapse (POP), is currently based on feeble evidence.

 

The Women’s Health Initiative Observational Study (WHI OS) has explored this issue, assessing prevalence, at baseline and after a 3-year time interval, of different forms of UI in 92,093 postmenopausal women between 50 and 80 years (53,569 with the uterus in place, 38,524 hysterectomized) [4]. This is the largest cohort of women in which information on UI has ever been gathered.

 

The main finding of the study is that prior removal of the uterus is associated with a slightly higher prevalence of UI at baseline (odds ratio (OR) range 1.09–1.69, [i]p[/i] < 0.0001) and over the 3-year study period (OR 1.18–1.20, [i]p[/i] = 0.0002). All types of UI (stress UI, urge UI or mixed UI) were similarly related to previous hysterectomy. In parallel, no statistical association was found with removal or conservation of the ovaries or with use of menopausal hormone therapy.

Author(s)

  • Tommaso Simoncini
    Department of Clinical and Experimental Medicine, University of Pisa, Italy

Citations

  1. Melville JL, Katon W, Delaney K, Newton K. Urinary incontinence in US women: a population-based study. Arch Intern Med 2005;165:537-42
    http://www.ncbi.nlm.nih.gov/pubmed/15767530
  2. Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50:1306-14
    http://www.ncbi.nlm.nih.gov/pubmed/17049716
  3. Mannella P, Palla G, Bellini M, Simoncini T. The female pelvic floor through midlife and aging. Maturitas 2013;76:230-4
    http://www.ncbi.nlm.nih.gov/pubmed/24055286
  4. Kudish BI, Shveiky D, Gutman RE, et al. Hysterectomy and urinary incontinence in postmenopausal women. Int Urogynecol J 2014 Jun 26. Epub ahead of print
    http://www.ncbi.nlm.nih.gov/pubmed/24964761
  5. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4-20
    http://www.ncbi.nlm.nih.gov/pubmed/19941278
  6. Hendrix SL, Cochrane BB, Nygaard IE, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005;293:93548
    http://www.ncbi.nlm.nih.gov/pubmed/15728164
  7. Ismail SI, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev 2010(9):CD007063
    http://www.ncbi.nlm.nih.gov/pubmed/20824855
  8. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 2004;190:27-32
    http://www.ncbi.nlm.nih.gov/pubmed/14749630
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