The menopause and urinary incontinence

The objective was to study the possible role of the menopause in adult female urinary incontinence (UI) etiology, using a cross-sectional population study comprising a random sample of adult females and self-reported data based on postal questionnaires.The study group comprised 915 women who reported continued menstruation and 636 women who had stopped menstruation after the age of 39; in total, 1551 women aged 40–59 years, from the Municipality of Aarhus, Denmark. Ooophorectomized or hysterectomized women not reporting menstruation were excluded.The main outcome measures were the period prevalence in 1987 of episodes of stress and urge urinary incontinence; prevalence of menopause and exposure to childbirth, gynecologic surgery, cystitis and obesity as indicated by body mass index more than 29; prevalence relative risks, as indicated by odds ratio of UI conditional on menopause and other prevalence risk indicators.The 1987 period prevalences of stress and urge urinary incontinence were 15.9% and 8.7%, respectively. Forty-one percent had ceased to menstruate. Irrespective of the UI risk indicators mentioned, UI prevalence was significantly raised from 1 year before until 1 year after the year of final menstruation. The findings suggest perimenopausal processes rather than the menopause in general to be responsible for an increased risk of developing UI. The elevation of UI prevalence in the perimenopause may reflect the adjustment of the female continence mechanism to function with a lower estrogen level than previously. Perimenopausal processes seem to contribute much less than surgical operations, for example, to the amount of UI in middle-aged women. This may affect assessment of the relevance of estrogen supplementation of menopausal UI patients aged 40–59.