Tuesday, February 22, 2005

More things I did wrong in my practice

Another day, another thing I did wrong when I practiced medicine:
TheMilwaukeeChannel.com - Health - Study: Hormone Therapy Makes Incontinence Worse, Not Better

By some estimates, up to half of all women over 50 will suffer from urinary incontinence. Many women take hormone replacement therapy because doctors believe it can reduce the risk of urinary leakage, but according to a new study, the opposite is true.

... Hendrix and her colleagues tracked the health of more than 27,000 post-menopausal women for one year to see if hormones reduced incontinence.

The study, published in Wednesday's issue of the Journal of the American Medical Association, showed that women who hadn't had leakage before taking the hormones were more likely to become incontinent, and women who were already incontinent were more likely to see their condition get worse...

... Women taking estrogen pills for one year were 53 percent more likely to develop urinary incontinence than women who took dummy pills. Women taking pills containing both estrogen and progestin faced a 39 percent higher risk.
I stopped doing clinical practice about 4-5 years ago, and it's been more years than that since I saw women for incontinence. Back then, however, a 50 yo woman with incontinence was a great candidate for estrogen therapy (w/ progestins usually): build up bones, reduce incontinence, reduce fracture risk, reduce heart disease risk, less dementia ...

Except none of those things, except the fracture, are felt to be true nowadays. Maybe this study is wrong (the design doesn't sound very robust), but I gather it's not the only study with similar results. It seems unlikely that estrogens are a great treatment for incontinence, and given their other issues I wouldn't use them for urinary incontinence today.

Sigh. Things wouldn't be so bad if I were confident that the newer therapies will hold up significantly better than the nostrums I was taught eons ago ...

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