Factors associated with worsening and improving urinary incontinence across the menopausal transition

Abstract

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.

Figure 1

* Change in reporting of incontinence over six years † For women who report incontinence at two or more visits: stress only represents women who reported stress type only at every visit they reported incontinence; urge only represents women who reported urge type only at every visit they reported incontinence, both stress and urge represents those women who reported both types of incontinence at every visit they reported incontinence; either stress or urge represents women who inconsistently reported either type without a pattern at every visit they reported incontinence.

Figure 2