Surprise Bonus from Hormone Therapy in Menopause

Benefits of hormone therapy (HT) to treat menopausal symptoms included fewer nighttime trips to the bathroom for some patients, a small trial showed.

In 245 postmenopausal women treated with various types of HT and followed for 6 months, the percentage of those who woke two or more times to go to the bathroom at night decreased from 28% at baseline to 16% post-treatment (P<0.001), said Kim Pauwaert, MD, of Ghent University Hospital in Belgium, and colleagues.

In the study online in Menopause: The Journal of the North American Menopause Society, the researchers said the improvement was explained primarily by better sleep quality in women treated with estrogen plus progesterone and tissue-selective estrogen complex. In the first group, a sleep score as assessed by questionnaire improved from a median of 5.5 at baseline to 0 after treatment (P<0.001). In the latter group, the sleep score fell from a median of 10 at baseline to 4.5 post-treatment (P<0.001).

The percentage of women treated with estrogen alone who reported waking two or more times to go to the bathroom also fell from 25% at baseline to 21% at 6 months after therapy (P=0.03). This group had no significant change in sleep score, however. Instead, there was a significant drop in the percentage of women reporting an urgent need to urinate at night, from 36% at baseline to 19% post-treatment (P=0.039).

“This pilot study demonstrated a significant reduction in nocturia and its associated bother when different HT options were given for 6 months. This finding may relate to a significant improvement in sleep quality,” the study authors wrote.

“To our knowledge, this study is the first to assess the relation between different menopausal HT options and nocturia,” the team added. “The findings of this study are important, as both the reduction of nocturia and the associated bother have implications on women’s health and quality of life. This study supports a hypothesis to test in a future randomized study, namely that different systemic and vaginal estrogens will be more effective at reducing nocturia frequency than maintaining hormone depletion.”

The lack of estrogen in postmenopausal women can lead to nocturia via bladder dysfunction, sleep disorders such as apnea and hot flushes, and alterations in renal water and salt handling, the researchers explained.

The prospective study included 245 postmenopausal women with a median age of 53, categorized into four groups based on their treatment:

• Estrogen plus progesterone (133 patients)

• Estrogen only in patients with a prior hysterectomy (47 patients)

• Tissue-selective estrogen complex in those with an intolerance or contraindication to progesterone (33 patients)

• No treatment (32 patients)

The study did not include women treated with vaginal estrogens.

All women were asked to complete two standardized questionnaires before they started hormone therapy and again after 6 months of treatment: the International Consultation on Incontinence Questionnaire Nocturia Module and the Targeting the individual’s Aetiology of Nocturia to Guide Outcomes (TANGO), which included questions about cardiometabolic symptoms such as edema, sleep quality, urinary tract symptoms such as urgency, and overall well-being.

Statistical analysis included Chi-square tests for comparisons of bladder symptoms such as urgency and nocturia. The McNemar test was used to analyze differences in the specific questions of the TANGO before and after HT treatment.

Limitations of the study, the authors said, included the lack of randomization and the possibility of selection bias, since participants were recruited during a routine visit at a menopause clinic; this meant that the cohort was potentially not a reflection of the general population of postmenopausal women, especially since the women in the study were all healthy individuals without significant comorbidities. In addition, nocturia was assessed only by the questionnaires rather than with voiding diaries or frequency volume charts.