Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Waetjen, L.E., W.Y. Ten, J.J. Ye, W.O. Johnson, G.A. Greendale, C.M. Sampselle, B. Sternfleld, Sioban D. Harlow, and E.B. Gold. 2008. "Factors associated with worsening and improving urinary incontinence across the menopausal transition." Obstetrics and Gynecology, 111(3): 667-677.
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.
LEVEL OF EVIDENCE: II
The natural history of urinary incontinence in midlife women is not well described. Cross-sectional epidemiological studies have found a higher prevalence in women aged 45–55 years, an age range that coincides with the menopause transition.1 This incontinence prevalence increase in midlife has been explained, in part, by the development of urogenital atrophy associated with estrogen loss around menopause.2 Yet progression through the menopause transition does not appear to increase the risk of developing incontinence.3 Other factors are important in the development of incontinence between ages 40 and 60: age, diabetes, obesity, and a high body mass index (BMI).4
Whether the transition from pre- to postmenopause affects existing incontinence, independently of other factors, is not known. There is little information about how change in factors over time, such as transition through the menopause stages or changes in weight and body distribution, can positively or negatively affect the severity of existing incontinence. Longitudinal studies are needed to provide insight into the natural history of this condition.
We aimed to evaluate factors associated with worsening and improving of incontinence symptoms in midlife women during a period of 6 years. Specifically, we examined whether stage of the menopause transition and other factors that can vary over time, such as changes in weight and waist-to-hip ratio affected the frequency of reported incontinence symptoms. We investigated factors associated with worsening and improving incontinence between each year and over the entire 6-year period.
Country of focus: United States.