Hormone Therapy Supports Postmenopausal Women with Nocturia

by | Apr 28, 2021 | 2021, Bladder Health, Menopause, Women's Health

Written by Joyce Smith, BS. This study explores the positive benefits of hormone therapy using estrogen on postmenopausal women with nocturia.

aging womanNocturia is a condition of frequent waking up during the night to urinate and is an increasingly common problem following menopause 1. Decreasing estrogen levels that accompany menopause can lead to bladder dysfunction 2 and sleep disorders such as apnea 3 and hot flashes 2. They can also affect the body’s ability to handle salt 4,5 which can result in increased urine volume overnight. Hormonal therapy (HT) is the treatment of disease or symptoms with naturally or synthetic hormones. The use of estrogen in combination with progesterone is the option of choice for women with intact ovaries to reduce endometrial hyperplasia risk while estrogen is an option for women who have had hysterectomies. For patients where progesterone is contraindicated, a tissue-selective estrogen complex (TSEC) is an available treatment option 6.

The following prospective study 7 explores whether HT using different systemic and vaginal estrogens would be more effective at reducing nocturia compared to no HT in postmenopausal women with reduced estrogen levels. Researchers randomized 245 postmenopausal women, median age of 53, into four treatment groups: Estrogen plus progesterone (E+P) (n =133), Estrogen only in patients with a prior hysterectomy (n=47), Tissue-selective estrogen complex (TSEC) (n=33), No treatment (NT) (n=32). Excluded from the study were women using vaginal estrogens, those with thyroid dysfunction or who used antihypertensive agents and all women who had a history of psychiatric or neurological disorders, alcohol or drug abuse, stroke, or breast cancer. The study’s objective was to explore the prevalence and impact of nocturia among postmenopausal women and the effect of HT on their quality of life. Data for analysis of sleep quality, nocturia and quality of life was obtained from two questionnaires that were completed before HT and again after 6 months of treatment.

Following  6 months of various  HT  treatments, the number of nightly trips to the bathroom  significantly decreased from 28% at baseline to 16% post-treatment (P<0.001) in the 245 postmenopausal women. The number of women who had one void at baseline increased from 45% to 51% after HT; the number of women with no voids at baseline increased from 27% to 32% after HT.

When considering individual treatment options, the E+P and TSEC groups both had a significant reduction in nocturnal frequency (P=0.018 for both), an improvement of 24.8% at baseline to 12.8% after HT treatment. Women treated with only estrogen (who reported waking two or more times to void) reduced their nightly bathroom trips from 25% at baseline to 21% at 6 months after HT (P=0.03). While only the estrogen group of women experienced no significant changes in sleep patterns, those in the group who reported an urgency to void at night dropped significantly from 36% at baseline to 19% post-HT treatment (P=0.039). The no HT treatment group experienced no changes in nocturnal frequency.

Overall, the significant decrease in nocturia in postmenopausal women following HT therapy was accompanied by a significant improvement in sleep quality. These results align with previous research by Kok et al in which 65.4% of women had decreased nocturia with E + P treatment 8. Previous research also validates a significant decrease in nocturia following both oral and vaginal treatment in postmenopausal women with hysterectomy 9. Nocturnal frequency is a bother for women in that it compromises their sleep and quality of life. Future research that explores how improved bladder dysfunction relates to decreased urgency is recommended.

Source: Pauwaert, Kim, An-Sofie Goessaert, Lynn Ghijselings, Wendy Bower, An Mariman, Dirk Vogelaers, Herman Depypere, and Karel Everaert. “Hormone therapy as a possible solution for postmenopausal women with nocturia: results of a pilot trial.” Menopause (New York, NY) (2021).

2021 by The North American Menopause Society

Click here to read the full text study.

Posted April 28, 2021.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Terauchi M, Hirose A, Akiyoshi M, Owa Y, Kato K, Kubota T. Prevalence and predictors of storage lower urinary tract symptoms in perimenopausal and postmenopausal women attending a menopause clinic. Menopause. 2015;22(10):1084-1090.
  2. Hristov KL, Parajuli SP, Provence A, Rovner ES, Petkov GV. Nongenomic modulation of the large conductance voltage- and Ca(2+)-activated K(+) channels by estrogen: A novel regulatory mechanism in human detrusor smooth muscle. Physiological reports. 2017;5(14).
  3. Perger E, Mattaliano P, Lombardi C. Menopause and Sleep Apnea. Maturitas. 2019;124:35-38.
  4. Stachenfeld NS, DiPietro L, Palter SF, Nadel ER. Estrogen influences osmotic secretion of AVP and body water balance in postmenopausal women. The American journal of physiology. 1998;274(1):R187-195.
  5. Harvey PJ, Morris BL, Miller JA, Floras JS. Estradiol induces discordant angiotensin and blood pressure responses to orthostasis in healthy postmenopausal women. Hypertension. 2005;45(3):399-405.
  6. Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109-150.
  7. Pauwaert K, Goessaert AS, Ghijselings L, et al. Hormone therapy as a possible solution for postmenopausal women with nocturia: results of a pilot trial. Menopause. 2021.
  8. Kok AL, Burger CW, van de Weijer PH, Voetberg GA, Peters-Muller ER, Kenemans P. Micturition complaints in postmenopausal women treated with continuously combined hormone replacement therapy: a prospective study. Maturitas. 1999;31(2):143-149.
  9. Long CY, Liu CM, Hsu SC, Chen YH, Wu CH, Tsai EM. A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomized postmenopausal women. Fertil Steril. 2006;85(1):155-160.