Scolaris Content Display Scolaris Content Display

Oestrogen therapy for urinary incontinence in post‐menopausal women

Esta versión no es la más reciente

ver la versión actual 17 octubre 2012
Contraer todo Desplegar todo

Referencias

Ahlstrom 1990#S {published data only}

Ahlström K, Sandahl B, Sjöberg B, Ulmsten U, Stormby N, Lindskog M. Effect of combined treatment with phenylpropanolamine and estriol, compared with estriol treatment alone, in postmenopausal women with stress urinary incontinence. Gynecologic and Obstetric Investigation 1990;30(1):37‐43. [MEDLINE: 91033282; 338]

Beisland 1984#L {published data only}

Beisland HO, Fossberg E, Moer A, Sander S. Urethral sphincteric insufficiency in postmenopausal females: treatment with phenylpropanolamine and estriol separately and in combination. Urologia Internationalis 1984;39:211‐6. [MEDLINE: 85018049; 690]

Blom 1995#S {published data only}

Blom M, Sommers B. The effects of an estradiol transdermal therapuetic system, alone and in combination with naproxen, on urge incontinence in elderly women: a pilot study. Current Therapeutic Research, Clinical and Experimental 1995;56(10):1100‐4. [6083]

Cardozo 1993 S {published data only}

Cardozo L, Rekers H, Tapp A, Barnick C, Shepherd A, Schussler B, et al. Oestriol in the treatment of postmenopausal urgency: a multicentre study. Maturitas 1993;18(1):47‐53. [MEDLINE: 94150369; 1223]

Cardozo 2001 L {published and unpublished data}

Benness C. Vaginal oestradiol for postmenopausal urinary symptoms ‐ a double‐blind placebo‐controlled study [MD Thesis]. University of Sydney, 1992. [16396]
Benness C. Vaginal oestradiol for postmenopausal urinary symptoms ‐ a double‐blind placebo‐controlled study [abstract]. Proceedings of the FIGO meeting, Stockholm. 1992. [16397]
Benness CJ, Wise BG, Cutner A, Cardozo L. Does low dose vaginal estradiol improve frequency and urgency in postmenopausal women?. American Urogynecology Society 13th annual meeting, Sept 27‐30 1992. Cambridge, Massachussetts, USA, 1992:281. [14578]
Cardozo LD, Wise BG, Benness CJ. Vaginal oestradiol for the treatment of lower urinary tract symptoms in postmenopausal women ‐ A double‐blind placebo‐controlled study. Journal of Obstetrics and Gynaecology 2001;21(4):383‐5. [15720]

Chompootaweep 1998 SL {published data only}

Chompootaweep S, Nunthapisud P, Trivijitsilp P, Sentrakul P, Dusitsin N. The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study. Clinical Pharmacology and Therapeutics 1998;64(2):204‐10. [MEDLINE: 98397118; 12894]
Chompootaweep S, Nunthapisud P, Trivijitsilp P, Sentrakul P, Dusitsin N. The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study [Abstract]. Proceedings of the 8th International Congress on the Menopause; Sydney; Nov 3‐7, 1996. 1996:87‐8. [5184]

Dessole 2004 L {published data only}

Dessole S, Rubattu G, Ambrosini G, Gallo O, Capobianco G, Cherchi PL, et al. Efficacy of low‐dose intravaginal estriol on urogenital aging in postmenopausal women. Menopause 2004;11(1):49‐56. [16649]

Ek 1980#S {published data only}

Ek A, Anderson KE, Gullberg B, Ulmsten U. Effect of oestradiol and combined norephedrin and oestradiol treatment on female stress incontinence. Zentralbibliothek Gynaekologie 1980;102(15):839‐44. [MEDLINE: 81105288; 777]

Enzelsberger 1990 L {published data only}

Enzelsberger H, Schatten C, Kurz C, Zorzi P. Treatment of female urge incontinence by local oestrogen therapy [Zur Behandlung der weiblichen Urge‐Inkontinenz durch lokale Oestrogentherapie]. Gynaekologische Rundschau 1990;30, Suppl 1:235‐6. [MEDLINE: 91177440; 305]

Enzelsberger 1991a L {published data only}

Enzelsberger H, Kurz C, Schatten C, Huber J. Effects of intravaginal application of oestriol tablets in women with urge incontinence [Zur Wirksamkeit einer intravaginalen Oestrioltablettenapplikation bei Frauen mit Urge‐Inkontinenz]. Geburtshilfe und Frauenheilkunde 1991;51(10):834‐8. [MEDLINE: 92104418; 238]

Enzelsberger 1991b L {published data only}

Enzelsberger H, Kurz C, Schatten C, Huber J. Effects of intravaginal application of oestriol tablets in women with urge incontinence [Zur Wirksamkeit einer intravaginalen Oestrioltablettenapplikation bei Frauen mit Urge‐Inkontinenz]. Geburtshilfe und Frauenheilkunde 1991;51(10):834‐8. [MEDLINE: 92104418; 238]

Fantl 1996 S {published data only}

Fantl JA, Richard C, Bump C, Robinson D, McClish DK, Wyman JF, and the Continence Program for Women Research Group. Efficacy of estrogen supplementation in the treatment of urinary incontinence. Obstetrics and Gynecology 1996;88(5):745‐9. [4860]

Grady 2001 S {published data only}

Grady D, Applegate W, Bush T, Furberg C, Riggs B, Hulley SB. Heart and Estrogen/Progestin Replacement study (HERS): Design, methods and baseline characteristics. Controlled Clinical Trials 1998;19:314‐35. [15451]
Grady D, Brown JS, Vittinghoff E, Applegate W, Warner E, Snyder T. Postmenopausal hormones and incontinence: the Heart and Estrogen/Progestin Replacement Study. Obstetrics and Gynecology 2001;97(1):116‐20. [11845]
Sherman AM, Shumaker SA, Kancler C, Zheng B, Reboussin DM, Legault C, et al. Baseline health‐related quality of life in postmenopausal women with coronary heart disease: the Estrogen Replacement and Atherosclerosis (ERA) trial. Journal of Women's Health 2003;12(4):351‐62.

Henalla 1989 L {published data only}

Henalla SM, Hutchins CJ, Castleden CM. Conservative management of urethral sphincter incompetence [Abstract]. Neurourology & Urodynamics 1987;6(3):191‐2. [2689]
Henalla SM, Hutchins CJ, Robinson P, MacVicar J. Non‐operative methods in the treatment of female genuine stress incontinence of urine. Journal of Obstetrics and Gynaecology 1989;9:222‐5. [2637]

Henalla 1990 L {published data only}

Henalla SM, Millar DR, Wallace KJ. Surgical versus conservative management for post‐menopausal genuine stress incontinence of urine [Abstract]. Neurourology and Urodynamics 1990;9(4):436‐7. [5117]

Hendrix 2005 S {published data only}

Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, Aragaki A, Naughton MJ, Wallace RB, McNeeley SG. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005;293(8):935‐48. [20122]
Pal L, Hailpern SM, Santoro NF, Freeman R, Barad D, Kipersztok S, et al. Association of pelvic organ prolapse and fractures in postmenopausal women: analysis of baseline data from the Women's Health Initiative Estrogen Plus Progestin trial.[see comment]. Menopause 2008;15(1):59‐66.

HendrixA (no uterus) S {published data only}

Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005;293(8):935‐48. [20122]

HendrixB (+ uterus) S {published data only}

Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, Aragaki A, Naughton MJ, Wallace RB, McNeeley SG. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005;293(8):935‐48. [20122]

Hilton 1990 SL {published data only}

Hilton P, Tweddell AL, Mayne C. Oral and intravaginal estrogens alone and in combination with alpha‐adrenergic stimulation in genuine stress incontinence. International Urogynecology Journal 1990;1:80‐6. [2675]

Ishiko 2001 S {published data only}

Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S. Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial. Journal of Reproductive Medicine 2001;46(3):213‐20. [12340]

Jackson 1999 S {published data only}

Jackson S, Shepherd A, Abrams P. Does oestrogen supplementation improve the symptoms of postmenopausal urinary stress incontinence? A double blind placebo controlled trial. Neurourology and Urodynamics 1997;16 (5):350‐1. [5837]
Jackson S, Shepherd A, Abrams P. Subjective benefit from HRT in postmenopausal urinary stress incontinence? A double blind placebo controlled trial. International Urogynaecology Journal and Pelvic Floor Dysfunction 1997;8 Suppl(1):51. [5170]
Jackson S, Shepherd A, Abrams P. The effect of oestradiol on objective urinary leakage in postmenopausal stress incontinence; a double blind placebo controlled trial [Abstract]. Neurourology and Urodynamics 1996;15 (4):322‐3. [4616]
Jackson S, Shepherd A, Brookes S, Abrahams P. The effect of oestrogen supplementation on post‐menopausal urinary stress incontinence: a double‐blind placebo‐controlled trial. British Journal of Obstetrics and Gynaecology 1999;106(7):711‐8. [MEDLINE: 99355483; 8840]

Judge 1969# {published data only}

Judge TG. The use of quinestradol in elderly incontinent women, a preliminary report. Gerontologia Clinica 1969;11(3):159‐64. [MEDLINE: 69189132; 885]

Kinn 1988#S {published data only}

Kinn AC, Lindskog M. Estrogens and phenylpropanolamine in combination for stress urinary incontinence in postmenopausal women. Urology 1988;32(3):273‐80. [MEDLINE: 88322669; 476]

Kurz 1993 L {published data only}

Kurz C, Nagele F, Sevelda P, Enzelsberger H. Intravesical application of estriol in sensory urge incontinence ‐ a prospective study [Intravesikal appliziertes Oestriol bei sensorischer Urgeinkontinenz ‐ eine prospektive Studie]. Geburtshilfe und Frauenheilkunde 1993;53(8):535‐8. [MEDLINE: 93387641; 99]

Lose 2000 L {published data only}

Lose G, Englev E. A randomised study to compare the efficacy of a vaginal ring (estradiol) with a vaginal pessary (estriol) in postmenopausal women (PMW) with urinary symptoms (US) [Abstract]. Proceedings of the 8th International Congress on Menopause; 1996 Nov 3‐7; Sydney. 1996:87. [11866]
Lose G, Englev E. Oestradiol‐releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. British Journal of Obstetrics and Gynaecology 2000;107(8):1029‐34. [MEDLINE: 20410404; 9816]

Melis 1997 L {published data only}

Melis GB, Paoletti AM, Murgia C, Piras B, Pilia I, Romagnino S, et al. Vaginal oestriol and benzidamine in the treatment of urogenital disturbances of the climacteric [Estriolo vaginale e benzidamina nel trattamento dei disturbi uroginecologici del climaterio]. Giornale Italiano Di Ostetricia e Ginecologica 1997;19(5):303‐12. [5929]

Ouslander 2001 S {published data only}

Ouslander J, Greendale G, Uman G, Schnelle J. Effects of oral oestrogen/progestin among incontinent female nursing home residents [Abstract]. Neurourology and Urodynamics 1998;17(4):165‐6. [5693]
Ouslander JG, Greendale GA, Uman G, Lee C, Paul W, Schnelle J. Effects of oral estrogen and progestin on the lower urinary tract among female nursing home residents. Journal of the American Geriatrics Society 2001;49:803‐7. [MEDLINE: 21347846; 15403]

Rufford 2003 S {published and unpublished data}

Rufford J, Hextall A, Cardozo L, Khullar V. A double blind placebo controlled trial on the effects of 25mg oestradiol implants on the urge syndrome in postmenopausal women. Personal communication. [16452]

Sacco 1990 L {published data only}

Sacco F, Rigon G, Carbone A, Sacchini, D. Transvaginal estrogen therapy for stress incontinence [Terapia estrogenica transvaginale dell'incontinenza urinaria da sforzo]. Minerva Ginecologica 1990;42(12):539‐44. [MEDLINE: 91211857; 10496]

Samsioe 1985 #S {published data only}

Samsioe G, Jansson I, Mellstroem D, Svanborg A. Occurrence, nature and treatment of urinary incontinence in a 70‐year‐old female population. Maturitas 1985;7(4):335‐42. [MEDLINE: 86091608; 609]

Tinelli 2007 {published data only}

Tinelli A, Malvasi A, D'Anna L, Tinelli R, Perrone A, Tinelli FG. Presurgical promestriene therapy in postmenopausal women with stress urinary incontinence. Gynecological Endocrinology 2007;23(8):445‐50.

Tseng 2007 {published data only}

Tseng LH, Liang CC, Chang YL, Lin YH, oong YK, ang A, A randomized comparative study of vaginal estrogen cream in postmenopausal women with overactive bladder syndrome (Abstract number 27). International Urogynecology Journal and Pelvic Floor Dysfunction 2007;18(Suppl 1):S15‐6.

Walter 1978 S {published data only}

Walter S, Wolf H, Barlebo H, Jensen HK. Urinary incontinence in postmenopausal women treated with oestrogens. A double‐blind clinical trial. Urologia Internationalis 1978;33:135‐43. [2659]

Walter 1990 S {published data only}

Walter S, Kjærgaard B, Heisterberg L, Jakobsen H, Klarskov P, Lose G, et al. Stress urinary incontinence in postmenopausal women treated with phenylpropanolamine and estrogen: a randomised blind placebo‐controlled study. Proceedings of the 18th Annual Meeting of the International Continence Society, Oslo, Norway, 1‐3 September. 1988:282‐3. [12052]
Walter S, Kjærgaard B, Lose G, Andersen JT, Heisterberg L, Jakobsen H, et al. Stress urinary incontinence in postmenopausal women treated with oral estrogen (estriol) and an alpha‐adrenoceptor‐stimulating agent (phenylpropanolamine): a randomized double‐blind placebo‐controlled study. International Urogynaecology Journal 1990;1:74‐9. [2657]

Wilson 1987 S {published data only}

Wilson PD. Female genuine stress incontinence. An objective study of aspects of its aetiology, investigation and conservative treatment [MD Thesis]. Glasgow: Glasgow University, 1981:218‐24. [27332]
Wilson PD, Faragher B, Butler B, Bu'lock D, Robinson EL, Brown ADG. Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in postmenopausal women. British Journal of Obstetrics and Gynaecology 1987;94(6):568‐74. [MEDLINE: 87299556; 513]

Zullo 2005 L {published data only}

Zullo MA, Plotti F, Calcagno M, Palaia I, Muzii L, Manci N, et al. Vaginal estrogen therapy and overactive bladder symptoms in postmenopausal patients after a tension‐free vaginal tape procedure: a randomised clinical trial. Menopause 2005;12(4):421‐7. [20805]

Brandstettter 1961 {published data only}

Brandstetter F. [Results of the medical therapy of functional urine incontinence]. Wiener Klinische Wochenschrift 1961;73(33/34):556‐7. [21999]

Cardozo 1990 {published data only}

Cardozo L. Role of estrogens in the treatment of female urinary incontinence. Journal of the American Geriatics Society 1990;38(3):326‐8. [MEDLINE: 90187647; 366]

Castillo 1999 {published data only}

Castillo E, Saibene H, Varela R, Souza M. Periurethral vascular resistance index and local estrogen therapy in patients with stress urinary incontinence. Proceedings of the 29th Annual Meeting of the International Continence Society, Denver, Colorado, 23‐26 August 1999. 1999:147. [9916]

Ciaccia 2002 {published data only}

Angelina Ciaccia, S Goldstein, Johnson, S.Watts, L.Plouffe Jr. Incidence and severity of urinary incontinence in postmenopausal women participating in a placebo controlled clinical trial of raloxifene and oestrogen. the 10th world congress on the menopause2002. [17186]

Ciaccia 2002a {published data only}

Ciaccia A, Goldstein S, Johnson S, Watts S, Draper M, Plouffe L. Incidence and severity of urinary incontinence in postmenopausal women participating in a placebo‐controlled trial of raloxifene and estrogen (Abstract number P378). Journal of the American Geriatrics Society2002; Vol. 50, issue 4:S134.

Foidart 1991 {published data only}

Foidart JM, Vervliet J, Buytaert P. Efficacy of sustained‐release vaginal oestriol in alleviating urogenital and systemic climacteric complaints. Maturitas 1991;13(2):99‐107. [MEDLINE: 92017262; 12895]

Foster 12017 {published data only}

Foster DC, Palmer M, Marks J. Effects of vulvovaginal estrogen on sensorimotor response of the Lower Genital tract: A randomised Controlled Trial. Obstetrics and Gynaecology 1999;94(2):232‐7. [12017]

Howie 1997 {published data only}

Howie H, Heimer G, Larson G, Feldt G, Sundstroem G, Risberg B. The effect of estrogen on stress urinary incontinence in postmenopausal women, preliminary results [Abstract]. Proceedings of the International Continence Society, 27th Annual Meeting; Yokohama, Japan; 1997 Sep 23‐26;. 1997:297. [5848]

Kok 1999 {published data only}

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):143‐9. [MEDLINE: 99243595; 11868]
Kok ALM, Burger CW, van de Weijer PHM, Voetberg GA, Peters‐Muller ERA, Kenemans P. The effect of the dydrogesterone dose in continuously combined HRT regimens on micturition complaints. Proceedings of the 8th International Congress on Menopause, Sydney, Australia, 3‐7 November. 1996:88. [11867]

Long 2006 {published data only}

Long C, Lui C, Hsu S, Chen Y, Wu C, Tsai E. A randomized comparative study of the effects of oral and topical estrogen therapy on the lower urinary tract of hysterectomised postmenopausal women. American Society for Reproductive Medicine 2006;85(1):155‐60. [22078]

Mikkelsen 1995 {published data only}

Mikkelsen AL, Felding C, Clausen HV. Clinical effects of preoperative oestradiol treatment before vaginal repair operation. A double‐blind randomized trial. Gynecologic and Obstetric Investigation 1995;40(2):125‐8. [MEDLINE: 96039299; 2851]

Molander 1990 {published data only}

Molander U, Milsom I, Ekelund P, Mellstrom D, Eriksson O. Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post‐menopause. Maturitas 1990;12(2):113‐20. [MEDLINE: 91074034; 11269]

Nilsson 1994 {published data only}

Nilsson K, Heimer GM. Ultra‐low‐dose transdermal estrogen therapy in postmenopausal urogenital estrogen deficience ‐ a placebo‐controlled study. Menopause 1994;1(4):191‐7. [26559]

Notelovitz 1995 {published data only}

Notelovitz M. Estrogen therapy in the management of problems associated with urogenital ageing: a simple diagnostic test and the effect of the route of hormone administration. Maturitas 1995;22(Suppl.):S31‐3. [MEDLINE: 96371951; 2712]

Palomba 2001 {published data only}

Palomba S, Napolotano V, Sammartino A, Di Spiezio SA, Vassallo M, Mandato V, et al. Effect of estriol treatment per vaginum before Burch culposuspension. Minerva Ginecologica 2000;53(2):141‐5. [12281]

Poreba 1981 {published data only}

Poreba R, Dudkiewicz J. Evaluation of selected pharmacological preparations in the treatment of stress urinary incontinence in women [Ocena wybranych preparatow farmacologicznych w leczeniu wysilkowego nietrzymania moczu u kobiet]. Ginekologia Polska. 1981;52(2):193‐9. [MEDLINE: 81237845; 745]

Reid 2004 {published data only}

Goldstein SR, Johnson S, Watts NB, Ciaccia AV, Elmerick D, Muram D. Incidence of urinary incontinence in postmenopausal women treated with raloxifene or estrogen. Menopause 2005;12(2):160‐4. [19160]
Reid IR, Eastell R, Fogelman I, Adachi JD, Rosen A, Netelenbos C, et al. A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women. Archives of Internal Medicine 2004;164(8):871‐9. [19160]

Rud 1980 {published data only}

Rud, T. The effects of estrogens and gestagens on the urethral pressure profile in urinary continent and stress incontinent women. Acta Obstetricia Gynecologica Scandinavica 1980;59(3):265‐70. [MEDLINE: 81036070; 788]

Schmidbauer 1992 {published data only}

Schmidbauer CP. Vaginal estriol administration in treatment of postmenopausal urinary incontinence [Vaginale Oestriolapplikation zur Behandlung der postmenopausalen Harninkontinenz]. Urologe 1992;31(6):384‐9. [MEDLINE: 93097525; 168]

Steinauer 2005 {published data only}

Steinauer JE, Subak LL, Grady D, Vittinghoff E, Brown J. Hormonal therapy for prevention or urinary Incontinence: The HERS study. Obstetrics and Gynaecology 2003;101 Suppl(4):10. [17197]
Steinauer JE, Waetjen E, Vittinghoff E, Subak LL, Hulley SB, Grady D, et al. Postmenopausal hormone therapy: does it cause incontinence?. American College of Obstetricians and Gynaecologists 2005;106(5):940‐5. [21291]

Valente 2000 {published data only}

Valente M, Dettori C, Feraudo E, Re ME. Pelvic‐floor: new therapeutic approach (Abstract). International Urogynecology Journal 2000;11 Suppl 1:97.

Vardy 2003 {published data only}

Vardy M, Lindsay R, Scotti RJ, Mikhail M, Richart RM, Neives J, et al. Short‐term urogenital effects of raloxifene, tamoxifen and estrogen. American Journal of Obstetrics and Gynaecology 2003;189(1):81‐8. [16541]

Vestergaard 2003 {published data only}

Vestergaard P, Hermann AP, Stilgren L, Tofteng CL, Sorensen OH, Eiken P, et al. Effects of 5 years of hormonal replacement on menopausal symptoms and blood pressure‐ a randomised controlled study. Maturitas 2003;46(2):123‐32. [16679]

Waetjen 2004 {published data only}

Waetjen LE, Brown JS, Modelska K, Blackwell T, Vittinghoff E, Cummings SR, et al. Effect of raloxifene on urinary incontinence: a randomized controlled trial.[see comment]. Obstetrics & Gynecology 2004;103(2):261‐6.

Bergman 1985 {published data only}

Bergman A, Bhatia NN. Estrogen induced cytological and functional urethral changes in postmenopausal women with genuine stress incontinence. Proceedings of the International Continence Society (ICS), 15th Annual Meeting, London, UK, 3‐6 September,1985:304‐5. [10927]

Ishiko 2001 {published data only}

Ishiko O, Hirai K, Sumi T, Tatsuta I, Ogita S. Hormone replacement therapy plus pelvic floor muscle exercise for postmenopausal stress incontinence. A randomized, controlled trial. Journal of Reproductive Medicine 2001;46(3):213‐20. [MEDLINE: 21200527; 12340]

Sant {published data only}

Sant M, Galea P, Brincat MP. A comparative study between oestrogen replacement therapy, anticholinergic treatment and a combination of both in the management of detrusor instability in postmenopausal women. The 10th World Congress on the Menopause2002. [17185]

Abrams 2002

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub‐committee of the International Continence Society. Neurourology and Urodynamics 2002;21(2):167‐78.

Alhasso 2005

Alhasso Ammar A, Glazener Cathryn MA, Pickard Robert, N'Dow James MO. Adrenergic drugs for urinary incontinence in adults. Cochrane Database of Systematic Reviews 2005, Issue 3. [DOI: 10.1002/14651858.CD001842.pub2; CD001842]

Barlow 1997

Barlow DH, Cardozo LD, Francis RM, Griffin M, Hart DM, Stephens E, et al. Urogenital ageing and its effect on sexual health in older British women. British Journal of Obstetrics and Gynecology 1997;104(1):87‐91. [MEDLINE: 8988703; 26]

Benness 1991

Benness C, Gangar K, Cardozo LD, Cutner A, Whitehead M. Do progestogens exacerbate incontinence in women on HRT?. Neurourology and Urodynamics 1991;10:316‐8.

Bezerra 2005

Bezerra Carlos CB, Bruschini Homero, Cody June D. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database of Systematic Reviews 2005, Issue 3. [DOI: 10.1002/14651858.CD001754.pub2; CD001754]

Bezerra 2007

Bezerra Carlos CB, Plata Mauricio S. Minimally invasive sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD006375; CD006375]

Blakeman 1996

Blakeman PJ, Hilton P, Bulmer JN. Mapping oestrogen and progesterone receptors throughout the female lower urinary tract. Neurourology and Urodynamics 1996;15(4):324‐5.

BNF 2002

British Medical Association and the Royal Pharmaceutical Society of Great Britain. British National Formulary. Oxford: Pharmaceutical Press, 2002. [ISSN: 0260‐535X]

Crown 1979

Crown S, Crisp AH. Crown‐Crisp Experimental Index. Kent, Hodder and Stoughton Educational, 1979. [8059]

Cutner 1992

Cutner A, Carey A, Cardozo LD. Lower urinary tract symptoms in early pregnancy. Journal of Obstetrics and Gynecology 1992;12:75‐8.

Dean 2006

Dean Nicola, Ellis Gaye, Herbison G Peter, Wilson Don. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD002239.pub2; CD002239]

Dumoulin 2006

Dumoulin Chantale, Hay‐Smith Jean. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/14651858.CD005654; CD005654]

Farquhar 2009

Farquhar C, Marjoribanks J, Lethaby A, Suckling JA, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women.. Cochrane Database of Systematic Reviews 2009 Art. No.: CD004143. DOI: 10.1002/14651858.CD004143.pub3., Issue 2.

Glazener 2001

Glazener Cathryn MA, Cooper Kevin. Anterior vaginal repair for urinary incontinence in women. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001755; CD001755]

Glazener 2002

Glazener Cathryn MA, Lapitan Marie Carmela M. Urodynamic investigations for management of urinary incontinence in children and adults. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD003195; CD003195]

Glazener 2004

Glazener Cathryn MA, Cooper Kevin. Bladder neck needle suspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD003636.pub2; CD003636]

Hannestad 2000

Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community‐based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord‐Trondelag. Journal of Clinical Epidemiology2000; Vol. 53, issue 11:1150‐7.

Hay‐Smith 2005

Hay‐Smith Jean, Ellis Gaye, Herbison G Peter. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database of Systematic Reviews 2005, Issue 3. [DOI: 10.1002/14651858.CD005429; CD005429]

Hay‐Smith 2008

Hay‐Smith Jean, Mørkved Siv, Fairbrother Kate A, Herbison G Peter. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD007471; CD007471]

Herbison 2002

Herbison G Peter, Dean Nicola. Weighted vaginal cones for urinary incontinence. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD002114; CD002114]

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60.

Higgins 2008

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008].. The Cochrane Collaboration. Available from www.cochrane‐handbook.org.2008.

Iosif 1981

Iosif CS, Batra S, Ek A, Astedt B. Estrogen receptors in the human female lower urinary tract. American Journal of Obstetrics and Gynecology 1981;141(7):817‐20. [MEDLINE: 82088727; 34]

Iosif 1984

Iosif CS, Bekassy Z. Prevalence of genito‐urinary symptoms in the late menopause. Acta Obstetricia Gynecologica Scandinavica 1984;63(3):257‐60. [MEDLINE: 84227187; 704]

Jackson 1996

Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P. The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing. British Journal of Urology 1996;77(6):805‐12. [MEDLINE: 96334871; 8058]

Jolleys 1988

Jolleys JV. Reported prevalence of urinary incontinence in women in a general practice. BMJ (Clinical Research Edition) 1988;296(6632):1300‐2. [MEDLINE: 88252699; 12044]

Keegan 2007

Keegan Phil E, Atiemo Kofi, Cody June D, McClinton Samuel, Pickard Robert. Periurethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2007, issue 3. [DOI: 10.1002/14651858.CD003881.pub2; CD003881]

Kelleher 1997

Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. British Journal of Obstetrics and Gynaecology 1997;104(12):1374‐9. [MEDLINE: 98083933; 5489]

Kondo 1990

Kondo A, Kato K, Saito M, Otani T. Prevalence of handwashing incontinence in females in comparison with stress and urge incontinence. Neurourology and Urodynamics 1990;9:330‐1.

Kovoor 2008

Kovoor Elias Thomas, Datta Sam, Patel Anand. Pelvic floor muscle training in combination with another therapy compared with the other therapy alone for urinary incontinence in women. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD007172; CD007172]

Lapitan 2009

Lapitan Marie Carmela M, Cody June D, Grant Adrian. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD002912.pub3; CD002912]

Nabi 2006

Nabi Ghulam, Cody June D, Ellis Gaye, Hay‐Smith Jean, Herbison G Peter. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD003781.pub2; CD003781]

Patel 2008

Patel Anand, Datta Sam, Kovoor Elias Thomas. Pelvic floor muscle training versus other active treatments for urinary incontinence in women. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD007173; CD007173]

Rossouw 2007

Rossouw JE, Prentice RL, Manson JE, Wu L, Barad D, Barnabei VM, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297(13):1465‐77.

Roxburgh 2007

Roxburgh Campbell, Cook Jonathan, Dublin Norman. Anticholinergic drugs versus other medications for overactive bladder syndrome in adults. Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2007, issue 4. [DOI: 10.1002/14651858.CD003190.pub4; CD003190]

Sandvik 1993

Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. Journal of Epidemiology and Community Health 1993;47(6):497‐9. [MEDLINE: 94165633; 4595]

Shaikh 2006

Shaikh Shafaque, Ong Eng K, Glavind Karin, Cook Jonathan, N'Dow James MO. Mechanical devices for urinary incontinence in women. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD001756.pub4; CD001756]

Shumaker 1994

Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA. Health‐related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and Urogenital Distress Inventory Continence Program in Women (CPW) Research Group. Quality of Life Research 1994;3(5):291‐306. [MEDLINE: 95144118; 22]

Smith 1993

Smith P. Estrogens and the urogenital tract. Studies on steroid hormone receptors and a clinical study on a new estradiol‐releasing vaginal ring. Acta Obstetricia Gynecologica Scandinavica Supplement 1993;157:1‐26. [MEDLINE: 93342960; 15434]

Thomas 1980

Thomas TM, Plymat KR, Blannin J, Meade TW. Prevalence of urinary incontinence. British Medical Journal 1980;281(6250):1243‐5. [MEDLINE: 81041506; 6676]

Van Geelen 1981

Van Geelen JM, Doesburg WH, Thomas CM, Martin CB. Urodynamic studies in the normal menstrual cycle: the relationship between hormonal changes during the menstrual cycle and the urethral pressure profile. American Journal of Obstetrics and Gynecology 1981;141(4):384‐92. [MEDLINE: 82021318; 1]

Ware 1993

Ware JE. Measuring patients' views: the optimum outcome measure. BMJ 1993;306(6890):1429‐30. [MEDLINE: 93299224; 1]

Moehrer 2003

Moehrer B, Hextall A, Jackson S. Oetrogens for urinary incontinence in women. Cochrane Database of Systematic Reviews 2003, Issue 2.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Ahlstrom 1990#S

Methods

RCT (double blind crossover)
ITT

Participants

29 women
Incl: USI, postmenopausal
Excl: hypertension, significant bacteruria, previous breast or uterine cancer, residual urine, drugs (neuroleptics, sedatives, antihistamines, ephedrine, B‐blockers, gestagens, oestrogens within previous 2 months
Mean age 63 (range 51‐73) years
Mean weight 71 (range 55‐90) kg

Interventions

group A (n=29): 4mg oestriol + 50mg PPA twice daily for 6/52
group B (n=29): 4mg oestriol + placebo for 6/52

Outcomes

urodynamics, urinary diary, subjective assessment, assessment of atrophy, urethral + vaginal cytology, feeling of vaginal dryness, pad test

Notes

no useable data; adverse events: group 1: 1 sweating, 1 constipation, 1 insomnia; group 2: 1 gastritis, 1 paraesthesia, 1 tachycardic attack, 1 dizziness, 2 nausea, 1 vomiting, 1 constipation; losses to follow up: group 1:1

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

"Randomization was made in groups of 4"

Allocation concealment?

Unclear risk

no description

Blinding?
All outcomes

Low risk

double blind

Incomplete outcome data addressed?
All outcomes

Low risk

"all 29 completed, one woman withdrawn from analyses of second treatment period due to failure in medication"

Beisland 1984#L

Methods

randomised open comparative crossover trial; duration of study: 12/52; assessment after each 4/52 period of treatment

Participants

20 postmenopausal women
inclusion criteria: incontinence
exclusion criteria: neurological and gynaecological disorders, urinary tract infections or tumours, general conditions contraindicating oestrogen and phenylpropanolamine therapy

Interventions

group A (n=20): 1mg oestriol vaginally daily for 4/52, then 50mg phenylpropanolamine (PPA) orally twice daily for 4/52, then combined for 4/52
group B (n=20): 50 mg phenylpropanolamine twice daily for 4/52, then 1mg oestriol vaginally daily for 4/52, then combined for 4/52

Outcomes

subjective assessment of treatment result, urodynamics, atrophy evaluation by clinical picture, cytological investigation by urethral smear
definition of cure: patient described improvement as good, definition of improvement: patient reported improved, definition of failure: patient reported unchanged or worse

Notes

adverse events: 1 genital bleeding in period of combined treatment, 1 complete insomnia after 3 days with PPA
losses to follow up: 2 (same patients as for adverse events)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear

Blinding?
All outcomes

High risk

"randomised open comparative cross‐over trial"

Incomplete outcome data addressed?
All outcomes

Low risk

18 out of 20 completed the study.
Blom 1995#S

Methods

placebo controlled, single‐blind randomised crossover study
duration of study: 28/52

Participants

16 women,
inclusion criteria: ambulant elderly women with established detrusor instability; 13 out of 16 had hysterectomy
exclusion criteria: breast or endometria carcinoma, thromboembolic disorders, severe hypertension, cardiac failure, diabetes mellitus, peptic ulceration
drugs that could interact with effects of study medication were discontinued

Interventions

crossover study
group A(n=16): oestradiol TTS transdermal system 0.05 mg / day, patch twice weekly for 8/52
group B (n=16): oestradiol TTS transdermal system 0.05 mg / day, patch twice weekly + naproxen tablets 250 mg bd for 8/52
group C (n=16): placebo TTS transdermal system, patch twice weekly for 8/52
washout period of 2/52 followed each medication regimen

Outcomes

urinary diary, cystometry

Notes

no useable data; adverse events: skin reactions to transdermal system: mild erythema and itching, 2 patients had more severe cutaneous reactions, but continued with treatment, systemic adverse effects: mild breast tenderness, 1 patient with uterus experienced spotting
losses to follow‐up: 3, for reasons not related to study medication

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear

Blinding?
All outcomes

High risk

open‐label single blind (patients blinded?)

Incomplete outcome data addressed?
All outcomes

Low risk

16 out of 19 completed. "Drop out not related to study medication"
Cardozo 1993 S

Methods

multicentre study, 6 centres (10 participated, but 4 did not recruit any patients), countries: UK, NL, D, DK (London, Bristol, Maastricht, Munich, Aalborg, Cheltenham)
double‐blind placebo‐controlled RCT, randomisation code held centrally
duration of study 3/12, assessments at 1/12 with 3‐day urinary diary and 4‐point severity score + at 3/12 with subjective and objective investigations
definition of cure: absence of a specific symptom at 3/12 that was present at entry obtained from direct symptom questions

Participants

64 postmenopausal women with urodynamically confirmed urgency urinary incontinence
baseline characteristics comparable
inclusion criteria: ambulant, postmenopausal >1 year, FSH > 40 IU/l, oestradiol < 220 pmol/l, urgency urinary incontinence
exclusion criteria: symptoms present for > 3 years before menopause, voiding difficulty, pelvic anatomic defect requiring surgery, neurological disease, recent oestrogen usage (< 6/12), concomitant medication that could affect bladder or urethral function, standard contraindications to oestrogen therapy

Interventions

group A (n=34): oestriol orally 3 mg for 3/12
group B (n=30): placebo orally for 3/12

Outcomes

subjective assessment with doctor‐administered questionnaire concerning presence or absence of specific urinary symptoms (24 questions) and 4‐point severity score scale (9 questions), objective assessment with 3‐day urinary diary, filling and voiding cystometry, urethral pressure profile where available, vaginal smear for maturation index calculated by single pathologist;
definition of cure: absence of a specific symptom at 3/12 that was present at entry obtained from direct symptom questions

Number not cured: urgency urinary incontinence: A, 14/25; B, 16/23; stress incontinence: A, 5/11; B, 4/10

Notes

urgency incontinence stratified into motor and sensory urgency incontinence, motor urgency incontinence defined as uninhibited detrusor contractions exceeding 15 cm of water, sensory urgency incontinence defined as first desire to void during filling cystometry at less than 150 ml and a cystometric capacity of 400 ml in absence of detrusor activity
losses to follow‐up: group A : 3, group B: 5
no adverse outcomes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Low risk

A ‐ Adequate "Randomisation code was held centrally"

Blinding?
All outcomes

Low risk

"double blind"

Incomplete outcome data addressed?
All outcomes

Low risk

8 out of 64 women did not complete study (3 reason unknown,1 loss of motivation, 1 lack of efficacy, 1 UTI, 1 exclusion criteria, 1 did not start. Equal dropouts between groups

Cardozo 2001 L

Methods

double‐blind placebo‐controlled RCT
duration of study: 12/52, assessments at 4/52 and 12/52

Participants

105 post‐menopausal women,
inclusion criteria: at least 1 year since last menstrual period, FSH > 40 U/l, estradiol < 220 pmol/l, complaining of lower urinary tract
symptoms of urgency, frequency and/or urgency urinary incontinence with onset not earlier than 3 years prior to menopause;
exclusion criteria: currently or recently (within the last 6/12) on oestrogen therapy, present or past history of oestrogen dependent neoplasia, abnormal genital bleeding of unknown origin, present or past history of thromboembolic disorders, urinary or vaginal infection, recent commencement or change in diuretic treatment

Interventions

group A: 17B‐oestradiol vaginal pellet (Vagifem) 25 µgm at night for 12/52
group B: placebo pellet at night for 12/52

Outcomes

questionnaire and frequency/volume chart, urethral brushing for cytology, compliance check regarding tablet usage, urodynamics, MSU, FSH, LH, oestradiol, endometrial biopsy, visual analogue score, symptom assessment sheet, cystometry data sheet
key endpoints of interest: symptoms of frequency, urgency, nocturia at final visit

Notes

no useable data; no numbers of women in groups; no adverse events
losses to follow up: 9, of which 2 due to medical reasons (1 intercurrent medical disease, 1 died of myocardial infarction)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear no description

Blinding?
All outcomes

Low risk

double blind

Incomplete outcome data addressed?
All outcomes

High risk

In both groups three women failed to commence treatment. Outcome data on 106 out of 110 randomised

Chompootaweep 1998 SL

Methods

RCT; duration of study: 8/52, F/U at 2, 4, 8/52 patients not blinded

Participants

40 post‐menopausal women
inclusion criteria: urogenital symptoms caused by oestrogen deficiency: vaginal dryness, burning, itching, dyspareunia, urinary frequency, urgency, dyspareunia (no mention of urinary incontinence)
exclusion criteria: thromboembolic disorders, severe liver disease, oestrogen dependent tumour, high blood pressure (diastolic > 100 mm Hg), oestrogen treatment in 3/12 before study
baseline characteristics: age group a 54.2 group b 54.7, BMI group a 23.8 group b 25.3, duration of urogenital symptoms group a 1.5yrs group b 2 yrs

Interventions

group A (n=20): combined contraceptive pill vaginally at night, one tablet per week (250ng levonorgestrel + 30mg ethinyl oestradiol)
group B (n=20): 1g oestrogen cream (contains 0.625mg conjugated equine oestrogen) at night 3x first week, 2x second week, then once weekly

Outcomes

diary card to record use of drugs, side effects, urogenital symptoms; vaginal pH, cultures, smears, MSU
wet at 8 weeks group A 0/20 group B 0/20
frequency at 8 weeks A 2/20 B 3/20

urgency at 8 weeks A 3/20 B 3/20

Notes

not blinded as patients received either a tube of cream or tablets, before treatment. Nearly all women had bacteria in their urine, none of the patients had a symptomatic urinary tract infection during the 8 week trial

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear

Blinding?
All outcomes

Unclear risk

no mention

Incomplete outcome data addressed?
All outcomes

Low risk

no dropouts
Dessole 2004 L

Methods

RCT: placebo controlled, sealed opaque envelopes
Duration of study: 6 months
Follow up: none after end of treatment

Participants

88 post‐menopausal women
Groups comparable at baseline on age, menopause duration, duration of UI, bacteriuria
Inclusion: urodynamic stress incontinence (moderate to severe), urogenital atrophy, recurrent UTI
Exclusion: detrusor overactivity, abnormal maximal cystometric capacity, prolapse Grade II or III; systemic disorders, systemic disease, thromboembolic disease, biliary lithiasis, breast or uterine cancer, abnormal uterine bleeding, BMI>25

Interventions

group A (44): intravaginal oestriol ovules, 1 mg daily for 2 weeks, 2 mg weekly for 6 months
group B (44): matching placebo
Dropout: A: 4/44, B: 3/44 (discomfort, local adverse effects), + B: 4/44 (no benefit)

Outcomes

Incontinent at 6 months: group A: 37/44, group B; 44/44
Not improved at 6 months:group A: 14/44, group B: 37/44
Adverse effects: group A: 4/44,group B: 3/44 (caused dropout)
Significant bacteriuria: group A: 6/44, group B: 20/44

Notes

participants and outcome assessors blinded to treatment

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Low risk

A ‐ Adequate "sequenced, sealed, opaque envelopes"

Blinding?
All outcomes

Low risk

double blind "participants and investigators were blinded to the drug being dispensed and to the assigned treatment group"

Incomplete outcome data addressed?
All outcomes

Low risk

no dropouts
Ek 1980#S

Methods

RCT (double‐blind crossover in 5th and 6th weeks of the study); duration of study: 8/52, F/U at 8/52

Participants

16 post‐menopausal women with urodynamically proven GSI

Interventions

all women (n=16): oestradiol valerate 2mg daily for 3/52, then 1mg for 1/52
group A (n=13): oestradiol 1mg + norephedrine 200mg daily for 2/52 after first 4/52
group B (n=13): oestradiol 1mg + placebo daily for 2/52 after first 4/52
after 2 weeks, groups 1 and 2 crossed over to the opposite arm

Outcomes

residual urine, MSU, urodynamics, clinical stress test, periurethral vaginal biopsies, subjective symptoms

Notes

no useable data; adverse events: "few and acceptable", very small changes in BP, no uterine bleeding;
losses to follow up: group 2: 2, group 3: 1

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Enzelsberger 1990 L

Methods

RCT, duration of study 4/52

Participants

35 women
inclusion criteria: urgency symptoms, urgency urinary incontinence, frequency, nocturia
exclusion criteria: renal disease, infections in the urogenital area, anticholinergic or hormone therapy

Interventions

group A (n=15): 0.5 or 1 mg oestriol vaginally
group B (n=20): 2 mg oestriol vaginally

Outcomes

urinary diary, cystoscopy, urodynamics, urethral and vaginal smear

Notes

no endometrial stimulation or breast tenderness noted

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Enzelsberger 1991a L

Methods

placebo‐controlled RCT, randomisation following randomisation scheme, duration of study: 4/52

Participants

40 post‐menopausal women
inclusion criteria: urgency symptoms, urgency urinary incontinence, frequency ( 6 or more micturitions/day), nocturia (3 or more micturitions/ night)
exclusion criteria: neurological bladder problems, renal disease, diabetes, infections in the urogenital area, anticholinergic or hormone‐therapy, malignancy

Interventions

group A (n=15): 1 mg oestriol vaginally for 3/52
group B (n=15): 3 mg oestriol vaginally for 3/52
group C (n=10): placebo vaginally for 3/52

Outcomes

cystometry, urethral pressure profile, cystoscopy, urethral smear, urinary diary, MSU, FSH levels, E2 levels

Notes

adverse outcomes: breast tenderness in 2 patients in group 2
losses to follow up: group B: 2, group C: 1

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Enzelsberger 1991b L

Methods

as Enzelsberger A

Participants

Interventions

Outcomes

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Fantl 1996 S

Methods

multicentre trial, 2 centres, double‐blind placebo‐controlled RCT, patients stratified by baseline severity of symptoms, urodynamics and treatment site; blocked randomisation within each stratum at each site; sequenced sealed opaque envelopes
women and investigators were blinded to treatment allocated
duration of study 3/12

Participants

83 post‐menopausal women with UI

inclusion criteria: all patients ambulatory, community‐dwelling residents, age 45 or older, involuntary loss of urine at least once a week, GSI was diagnosed when urine was objectively seen to be lost during exertion in absence of DI; DI defined as involuntary detrusor contractions during retrograde subtracted provocative cystometry; hypooestrogenism = plasma E2 levels 30 pg/ml or less

exclusion criteria: institutionalisation, permanent catheterisation, impaired mental status, functional disability limiting use of toilet, neuropathic or uncontrolled metabolic conditions (e.g. diabetes mellitus), chronic UTI, reversible causes of urinary incontinence (e.g. faecal impaction), major contraindications for use of oestrogens (e.g. breast cancer)

Interventions

group A (n=39): conjugated equine oestrogens 0.625 mg for 30 days + medroxyprogesterone 10 mg for 10 days of each cycle
group B (n=44): placebo similar cyclic regimen
Women, clinicians and pharmacists were blinded to actual treatment

Outcomes

Data recorded in standardised urinary diaries

Primary outcome: number of incontinent episode per week, N, mean (SD): A 39, 10 (10), B 44 13 (14)

cure (definition not given), results provided as patient's perception of somewhat or much better: A 54% (21/39), B 45% (20/44), P= 0.435

secondary outcomes:
pad test (volume of urine loss): A 101 (150), B 50 (68)
number of voluntary diurnal micturitions per week: A 50 (14), B 49 (15)
number of voluntary nocturnal micturitions per week: A 9 (6), B 8 (5)
quality of life measurements generic: SF‐36 Health survey + Centre of epidemiological studies depression scale,
condition specific QoL:
Incontinence Impact Questionnaire‐revised (IIQ‐R): A 97 (87), B 100 (82)
Urogenital Distress Inventory (UDI): A 101 (58), B 102 (55)
E2 level: A 61 (42), B 10 (16) (placebo unchanged from baseline)
vaginal parabasal cell count: A 3±17%, B 49±43%

Notes

loss to follow up: 2, and 8 only had diary or QoL data. Groups not given, unclear if these are extra to the 83 with outcome data reported
patients also taking progesterone which may have altered results
power calculation: study had 80% power to detect a difference of 4.5 episodes per week

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

blocked randomisation

Allocation concealment?

Low risk

A ‐ Adequate sequenced,sealed, opaque envelopes, each containing the bottle number to be given to an individual patient

Blinding?
All outcomes

Low risk

Participants, clinicians and pharmacists blind to drug being dispensed

Incomplete outcome data addressed?
All outcomes

Low risk

no dropouts
Grady 2001 S

Methods

RCT, randomisation stratified by clinical centre, within‐strata treatment randomised in fixed size blocks

Follow up at 4 months then annually for 4 years

Participants

1525 participants age less than 80, post menopausal, with intact uterus, and at least 1 episode of UI per week
all patients had coronary heart disease
baseline characteristics in both groups similar for age, race, education, menopause age, parity, chronic medical conditions, smoking and alcohol consumption and BMI

Interventions

group A (n=768) conjugated oestrogen (Premarin) 0.625mg + medroxyprogesterone acetate (Cycrin) 2.5mg
group B (n=757) identical placebo
oral tablets

Outcomes

Worse or unchanged at 1 year: A 525/716, B 479/715
Worse or unchanged at 2 years: A 499/680, B 464/686
Worse or unchanged at 3 years: A 478/640, B 436/639
Worse or unchanged at 4 years: A 541/756, B 506/747

Number of incontinent episodes: A 5.5 per week (increase of 0.7), B 5.6 per week (decrease of 0.1)
Using drugs for incontinence by 4 years: A 49/756, B 31/747
Incontinence surgery by 4 years: A 10/756, B 7/747
No change in either group in frequency of stress or urgency urinary incontinence, or in diurnal or nocturnal frequency

Notes

compliance at 1st year: A 82%, B 88% still taking the treatment

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

Randomisation codes prepared prepared with computer generated random numbers. Stratified by site and performed using randomly permuted blocks of 4

Allocation concealment?

Low risk

A ‐ Adequate. Eligible participants assigned with equal probability to the two groups by tamper proof randomization

Blinding?
All outcomes

Low risk

Participants and investigators blind to treatment
Henalla 1989 L

Methods

RCT, duration of study: 3/12, follow up at 3/12 and 9/12

Participants

100 women;
inclusion criteria: urodynamically proven GSI;
exclusion criteria: complicated history of incontinence such as fistula or more than one previous incontinence surgery, major prolapse, absolute contraindication to oestrogen treatment

Interventions

group A (n=24): conjugated equine oestrogen vaginal cream (Premarin) 1.25 mg at night for 12/52
group B (n=25): no treatment

Outcomes

pad test, urethral pressure studies at 3/12, symptom questionnaire at 9/12
definition of cure: negative pad test after previous positive; improvement: more than 50% reduction in pad weights

Notes

numbers given as "cured or improved" and "unchanged"; recurrences of symptoms at 9/12 in women who had initially improved: group A: 3, group B: 1, group C: 3 (recurrence of symptoms immediately after discontinuing oestrogen treatment)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

"allocated at random"

Allocation concealment?

Unclear risk

B ‐ Unclear

Blinding?
All outcomes

High risk

not possible, drug compared to PFMT

Incomplete outcome data addressed?
All outcomes

Unclear risk

100 out of 104 evaluated no info on dropouts
Henalla 1990 L

Methods

RCT, duration of study: 6/52

Participants

26 postmenopausal women; inclusion criteria: GSI

Interventions

group A (n=11): conjugated equine oestrogen vaginal cream (Premarin) 2 g at night for 6/52
group B (n=7): control
all failures had surgical repair

Outcomes

vaginal pH, vaginal cell count from smear, pad test, electromyographic traces to assess urethral sphincter activity;
definition of failure: < 50% reduction from original pad test loss; numbers given as "cured or improved" and "unchanged"

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear

Blinding?
All outcomes

High risk

not possible
Hendrix 2005 S

Methods

RCT, 25,597 women
Central randomisation, computer based selection, double blind dispensing
Follow up at one year and then a subsample after 3 years
Baseline QOL, questionnaire, interview, examination and bloods

Participants

RCT of hormone replacement for prevention of coronary heart disease and hip fracture, with and without symptoms of stress, urgency urinary or mixed incontinence at baseline
Women all aged between 50‐79 years, post‐menopausal

Incontinent (wet) women (Populations 1 and 2)
Population 1: (hysterectomy) N=6528 at baseline, outcome data at one year N=5920
Population 2: (with uterus) N=9889 at baseline, outcome data at one year N=9121

Continent (dry) women (Populations 3 and 4)
Population 3: (hysterectomy) N=3473 at baseline, outcome data at one year N=3073
Population 4: (with uterus) N=5707 at baseline, outcome data at one year N=5182

All women on HRT treatment at baseline had to have 3 month washout
Whole sample comparable at baseline on age, education, illness, menopause, parity, breastfeeding history, hormone use, hysterectomy status, physical activity and smoking
Exclusion criteria: breast CA, other invasive carcinoma in the last ten years, venous thromboembolism, hypertriglyceridaemia, medical condition which may result in death in the next three years, unwilling or unable to be randomised to placebo, severe menopausal symptoms at washout
All women had a four week trial with placebo to which they had to show 80% adherence

Interventions

Population 1 (wet at baseline, without uterus):
group A (2950): conjugated equine oestrogen alone
group B (2970): matching placebo
Population 2 (wet at baseline, with uterus):
group C (n=4572): conjugated equine oestrogen + medroxyprogesterone acetate
group D (n=4549): matching placebo
Population 3 (continent at baseline, without uterus):
group E (1526): conjugated equine oestrogen alone
group F (1547): matching placebo
Population 4 (continent at baseline, with uterus):
group G (2675): conjugated equine oestrogen alone
group H (2507): matching placebo

Outcomes

Population 1 (wet at baseline, without uterus)
Likelihood of worsening amount of UI: A versus B: RR = 1.59 [95% CI 1.39 to 1.82]
Likelihood of worsening frequency of UI: A versus B: RR = 1.47 [1.35 to 1.61]
Likelihood of limitation of activities related to UI: A versus B: RR = 1.29 [1.15 to 1.45]

Population 2 (wet at baseline, with uterus)
Likelihood of worsening amount of UI: C versus D: RR = 1.20 [95% CI 1.06 to 1.36]
Likelihood of worsening frequency of UI: C versus D: RR = 1.38 [1.28 to 1.49]
Likelihood of limitation of activities related to UI: C versus D: RR = 1.18 [1.06 to 1.32]

Worsening was not related to one type of urinary incontinence alone

Population 3 (dry at baseline)
Any UI at 1 year: E, 557/1526, F, 368/1547 RR=1.53, [1.37 to 1.71]
Stress UI at 1 year: E, 266/1526, F, 131/1547 RR=2.15 [1.77 to 2.62]
Urgency UI at 1 year: E, 210/1526, F, 184/1547 RR=1.32 [1.10 to 1.58]
Mixed UI at 1 year: E, 76/1526, F, 50/1547 RR=1.79 [1.26 to 2.53]

Population 4 (dry at baseline)
Any UI at 1 year: G, 834/2675; H, 563/2507 RR=1.39 [1.27 to 1.52]
Stress UI at 1 year: G, 429/2675; H, 218/2507 RR=1.87 [1.61 to 2.18]
Urgency UI at 1 year: G, 304/2675, H, 272/2507 RR=1.15 [0.99 to 1.34]
Mixed UI at 1 year: G, 99/2675, H, 69/2507 RR=1.49 [1.10 to 2.01]

Notes

No data suitable for meta‐analysis were provided in the original report but these have been requested
Data used in generic inverse variance analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

"The study pill bottles had unique bar codes and computer based selection to enable double blinded dispensing"

Allocation concealment?

Low risk

A ‐ Adequate "Randomization was performed using a study database distributed by the WHI Clinical Coordinating Center to the local centers"

Blinding?
All outcomes

Low risk

double blind, clinic staff and participants

Incomplete outcome data addressed?
All outcomes

Unclear risk

At 1 year vital status was known for 99.9% of participants in the oestrogen + progesterone trial and 100% for those in oestrogen only trial??

At 1 year 9.7% of women taking oestrogen + progesterone and 6.6% taking placebo stopped taking the pills. Oestrogen alone 8.4% and placebo 8% stopped taking the pills

HendrixA (no uterus) S

Methods

RCT
As Hendrix 2005

Participants

Wet at baseline
Population 1: (hysterectomy) N=6528 at baseline, outcome data at one year N=5920

Interventions

Population 1 (wet at baseline, without uterus):
group A (2950): conjugated equine oestrogen alone
group B (2970): matching placebo

Outcomes

Population 1 (wet at baseline, without uterus)
Likelihood of worsening amount of UI: A versus B: RR = 1.59 [95% CI 1.39 to 1.82]
Likelihood of worsening frequency of UI: A versus B: RR = 1.47 [1.35 to 1.61]
Likelihood of limitation of activities related to UI: A versus B: RR = 1.29 [1.15 to 1.45]

Worsening was not related to one type of urinary incontinence alone

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
HendrixB (+ uterus) S

Methods

RCT
As Hendrix 2005

Participants

Wet at baseline
Population 2: (with uterus) N=9889 at baseline, outcome data at one year N=9121

Interventions

Population 2 (wet at baseline, with uterus):
group C (n=4572): conjugated equine oestrogen + medroxyprogesterone acetate
group D (n=4549): matching placebo

Outcomes

Population 2 (wet at baseline, with uterus)
Likelihood of worsening amount of UI: C versus D: RR = 1.20 [95% CI 1.06 to 1.36]
Likelihood of worsening frequency of UI: C versus D: RR = 1.38 [1.28 to 1.49]
Likelihood of limitation of activities related to UI: C versus D: RR = 1.18 [1.06 to 1.32]

Worsening was not related to one type of urinary incontinence alone

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Low risk

A ‐ Adequate
Hilton 1990 SL

Methods

double‐blind RCT, patients were randomised into 6 groups; duration of study 4/52, evaluation on day 28 of study

Participants

n= 60 women
Inclusion: USI, post‐menopausal
Exclusion: Undiagnosed vaginal bleeding, oestrogen therapy within preceding 6 months, malignancy of oestrogen‐dependent tissue, BP >160 mmHg systolic, >100 mmHg diastolic, previous thromboembolic disease, liver disease, patients withholding informed consent
Age range 45‐70 years

Interventions

A (10): Intravaginal oestrogen (2 gr nocturnal) + PPA (50 mg twice daily)
B(10): Intravaginal oestrogen (2 gr nocturnal) + placebo (twice daily)
C (10): Oral oestrogen (1.25 mg daily) + PPA (50 mg twice daily)
D (10): Oral oestrogen (1.25 mg daily) + placebo (twice daily)
E (10): PPA (50 mg twice daily)
F (10): Intravaginal placebo (nocturnal) + placebo (twice daily)
Duration of treatment: 4 weeks

Outcomes

Subjective improvement: A: 9/10, B: 1/9, C: 4/10 D: 2/10, E: 0/9, F: 2/11
Mean number of pads/day: A: 0.9, B: 0.3, C: 0.9, D: 1.3, E: 2, F: 1.1
Mean pad weights: A: 8, B: 4, C: 4, D: 4, E: 4, F: 12
Adverse events: A: 3/10, B: 3/10, C: 5/10, D: 5/10, E: 4/10, F: 3/10 (headache, nausea, flushing, sweating, tingling, breast tenderness, ecchymoses)
Side effects causing discontinuation: C: 1/10, E: 1/10

Notes

Data estimated from graphs
No SDs
Comparisons: Alpha adrenergic drug + oestrogen (I & III) versus oestrogen alone (II & IV) versus alpha‐adrenergic drug alone (V) versus placebo (VI)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear no description

Blinding?
All outcomes

Low risk

double blind
Ishiko 2001 S

Methods

randomised controlled trial

duration of study 2 years

monthly uterine ultrasound examination and 6‐monthly endometrial PAP smears

Setting: Japan

Participants

66 post‐menopausal women with stress urinary incontinence, age 54 to 75 years, groups comparable at baseline

Dropouts: a further 6 by choice, 1 for adverse drug reaction hepatopathy): A, 4; B, 3

inclusion criteria: stress urinary incontinence alone (based on questionnaires)

exclusion criteria: urgency or mixed urinary incontinence

10% of women had a previous hysterectomy

Interventions

A (32): PFMT + oestriol tablet (1 mg/day)

B (34): PFMT alone

PFMT was taught by a gynaecology specialist, supplemented by videotape. The aim was 15 minutes of exercise a day

Outcomes

Persisting incontinence: A: 7/32; B, 11/34

(Mild UI: A, 0/12; B, 2/11: Moderate UI: A, 3/14; B, 5/18: Severe UI: A, 4/6; B, 4/5)

Adverse effects: A: 1/36; B, 0/37

No report of effect on uterus

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

randomly assigned

Blinding?
All outcomes

High risk

Incomplete outcome data addressed?
All outcomes

Low risk

4 out of 36 withdrew from exercise and oestrogen group 3 out of 37 from exercise only group

Jackson 1999 S

Methods

double‐blind placebo‐controlled RCT, duration of study 6/12; no definition of cure given, but results of no demonstrable stress incontinence on repeat cystometry (urodynamically 'cured')

Participants

67 post‐menopausal women with urodynamically proven GSI; inclusion criteria: >12/12 post‐menopausal, not taken HRT in previous 12/12

exclusion criteria: cancer of endometrium, liver, breast; endometrial thickness > 4mm Included women who had had hysterectomy

Interventions

group A (n=33): oestradiol 2 mg orally for 6/12
group B (n=34): placebo orally similar regime

Outcomes

urinary diary for 1 week, SF‐36 + B‐FLUTS questionnaires, 1 hour perineal pad test, urodynamics, repeat trans‐vaginal sampling + Pipelle biopsy if endometrial thickness>6mm, compliance, serum oestradiol levels

Notes

losses to follow‐up: 3 in group A, 2 in group B; 1 patient in each group left at 3/12 for surgery, both were reassessed and data are included
adverse outcomes: 6 women taking oestradiol had breakthrough bleeding, they started taking cyclical progestogen, repeat investigations in progestogen‐free part of their cycle, no case of endometrial atypia

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

Randomisation sequence generated by computer in block sizes of 10 (5 oestradiol, 5 placebo)

Allocation concealment?

Low risk

A ‐ Adequate, randomised by hospital pharmacy

Blinding?
All outcomes

Low risk

women participants and care providers

Incomplete outcome data addressed?
All outcomes

Low risk

Three out of 33 on oestradiol failed to complete the trial, two out of 34 on placebo. One woman in each arm left trial at three months opting for surgery (included in the analysis)

Judge 1969#

Methods

multicentre trial, 2 hospitals; placebo‐controlled double‐blind crossover RCT, duration of study 5 weeks

Participants

20 post‐menopausal women, patients in two hospitals in geriatric long‐stay beds for at least 1 month, 10 patients confused, 1 demented, 8 mentally normal; 14 had neurological disease
types of incontinence divided into: incontinent and unaware of it; incontinent, aware but not distressed by it; incontinent, aware and distressed
patients divided naturally into two groups (two hospitals), one group mildly incontinent, one group severely incontinent
no change of diuretic during trial
excluded if faecally impacted

Interventions

group A (n=18): quinestradol 0.25 mg qds for 1/12
group B (n=18) placebo similar regime
all 18 patients had quinestradol and placebo, but not stated how many had quinestradol first and then placebo or placebo first and then quinestradol

Outcomes

observed numbers of incontinent episodes requiring bed change per week

Notes

no useable data; unclear if groups were treated identically as patients had neurological disease or confusion and lived in different geriatric hospitals; losses to follow up: 2 (from initial 20); patients too confused for subjective assessment

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

a set of random numbers was used

Allocation concealment?

Low risk

A ‐ Adequate, hospital pharmacist provided with active ingredient labelled capsule X and capsule Y along with an emergency sealed key for emergency use

Blinding?
All outcomes

Low risk

double blind
Kinn 1988#S

Methods

RCT (randomised double blind crossover)

Participants

36 post‐menopausal women
inclusion criteria: GSI
exclusion criteria: not mentioned
Mean age 66 (49‐82)
Urgency urinary incontinence n = 7, previous anti‐incontinence operation n = 8, previous gynaecological operations n = 5

Interventions

group A (n=36): oestriol 2mg orally + placebo twice daily
group B (n=36): oestriol 2 mg orally + PPA 50 mg twice daily
for 4/52

Outcomes

Subjective improvement: A: 9/30, B: 16/30
Leakage episode/day: A: 2.4, B: 2.4
Mean number of voids/day: A: 7.2, B: 6.9
Mean pad weight/day:A: 34.9, B: 24.9

Notes

no useable data; adverse events: dryness of the mouth + ? arrhythmia, itch, depression; but not clear on which treatment losses to follow up: 6 (3 intercurrent diseases, 3 possible drug effects: arrhythmia, itch, depression)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Low risk

A ‐ Adequate

Blinding?
All outcomes

High risk

crossover design
Kurz 1993 L

Methods

placebo‐controlled double‐blind RCT, duration of study: 4/52

Participants

42 post‐menopausal women
inclusion criteria: urgency urinary incontinence, frequency (6 or more micturitions/day), nocturia (3 or more micturitions/night)
exclusion criteria: endocrine diseases (diabetes mellitus), renal disease, acute or chronic UTI, any other medication for high BP or cardiac failure, previous treatment with parasympatholytics and/or oestrogens

Interventions

group A (n=21): 1 mg oestriol in 10 ml sesame‐oil intravesically (into the bladder) every other day for 3/52
group B (n=21): placebo (10 ml sesame‐oil every other day for 3/52)

Outcomes

urinary diary, MSU, first urge to void, max. bladder capacity, functional urethral length, maximum urethral closure pressure, depression coefficient, cystometry, cystoscopy to assess bladder mucosa, vaginal and urethral smears, hormone levels of LH, FSH, oestradiol, SHBG, urinary diary, subjective measurement with visual analogue scale, assessment of burning at micturition, pain at micturition, bladder spasms, nocturia, frequency

Notes

no adverse outcomes

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Lose 2000 L

Methods

open, randomised, multicentre, parallel‐group controlled trial with an active control, 26 gynaecologists clinics + 1 outpatient clinic at Danish county hospital; duration of study: 24/52

Participants

251 post‐menopausal women
inclusion criteria: at least 1 bothersome lower urinary tract symptom appearing at least 2 years after spontaneous or surgical postmenopause; exclusion criteria: known or suspected oestrogen‐dependent neoplasia, mammary, ovarian, uterine malignancies, vaginal bleeding of unknown origin, clinically significant liver disease, acute or intermittent porphyria, uterovaginal prolapse grade II or III, sex hormone treatment within last 6/12, previous participation in clinical trials within 3/12 prior to inclusion, signs of vaginal irritation other than atrophy derived, signs
of vaginal ulceration

Interventions

group A (n=134): oestradiol releasing vaginal ring, which constantly releases 7.5 mg oestradiol/24 hours, ring staying in situ for 12/52, then changed, in total treatment for 24/52
group B (n=117): oestriol vaginal pessaries 0.5 mg every 2nd day for 24/52

Outcomes

questionnaire with symptom assessment using visual analogue scale, gynaecological examination including atrophy and pH assessment, assessment of form of administration using 5‐point scale questionnaire, primary outcomes:
subjective assessment of urgency, frequency, nocturia, dysuria, stress and urgency urinary incontinence, secondary outcomes:
vaginal dryness, dyspareunia
Definition of cure: 'symptom‐free' : change from 'a minor problem / a problem / a major problem' to 'no problem'; improvement: change from 'a problem' to 'a minor problem' or from 'a major problem' to 'a problem / a minor problem', failure: 'no change': no change from 'a minor problem / a problem / a major problem', 'worse': change from 'no problem' to 'a minor problem / a problem / a major problem' or from 'a minor problem' to 'a problem / a major problem' or from 'a problem' to 'a major problem'

Notes

losses to follow up: group A: 5, group B: 3
adverse outcomes: 49 women experienced at least one adverse event: 34 adverse events in group A , 42 adverse events in group B
primary objective was to show equivalence between the two treatments

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Low risk

A ‐ Adequate, central office using numbers sequentially. No number was to be omitted

Blinding?
All outcomes

High risk

open

Incomplete outcome data addressed?
All outcomes

Unclear risk

254 randomised, three did not receive treatment 251 eligible for intention‐to‐treat analysis

Melis 1997 L

Methods

treatment assigned in random fashion; duration of study 3/12

Participants

50 post‐menopausal women
inclusion criteria: physiological menopause of at least 1 year

exclusion criteria: hormone treatment less than 6/12 ago, illness or malignancy that contraindicated oestrogen treatment, BP>140/80, positive MSU

Interventions

group A (n=25): oestriol vaginally 0.5 mg / day for 14/7, then alternate days for 3/12 in total
group B (n=25): oestriol vaginally 0.5 mg / day for 14/7, then alternate days for 3/12 in total + benzidamine 140 mg daily

Outcomes

Biochemical markers: azotamine, glucose, GPT, GOT, g‐GT, bilirubin, total cholesterol, triglycerides, HDL‐cholesterol, FSH, oestriol levels
Clinical evaluation of genital symptoms: pruritus, leucorrhoea, sensation of vaginal dryness, dyspareunia)
Evaluation of general climacteric symptoms: psychological, insomnia, headaches, irritability, depression, neurovegetative: hot flushes
Colposcopy
Vaginal cytology, karyopycnotic index

Every 15 days women were asked about side effects of treatment and filled in diary with intensity of symptoms

Notes

no adverse events, no losses to follow up; study designed to look at vaginal changes rather than at incontinence, incontinence forms part of menopausal symptoms

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Ouslander 2001 S

Methods

double‐blind placebo‐controlled RCT, randomisation by table of random numbers, odd and even number envelopes were kept in pharmacy
5 community nursing homes
duration of study: 6/12, assessments at 3/12 and 6/12

Participants

32 incontinent female nursing home residents
inclusion criteria: age 65 and older
exclusion criteria: short stay and/or medical instability, terminally ill, (severe cognitive impairment, history of breast or cervical cancer, wet less than once per day, enteral feeding, poor cooperation with screening procedures, severe physical immobility requiring a lift or 3 person transfer)

Interventions

group A (n=15): oestrogen 0.625 mg + progesterone 2.5 mg, oral tablets, daily for 6/12
group B (n=17): placebo daily for 6/12
subjects also received prompted voiding by research aides for 3‐day periods while wet checks were carried out; subjects with bacteriuria on baseline MSU had 7‐day course of norfloxacin

Outcomes

frequency (percentage of checks at which subjects were found to be wet by research staff during three 8‐hour days of prompted voiding) and volume (re‐weighing pre‐weighed pad tests) of urinary incontinence, appropriate toileting rate, bladder capacity, cough 'stress test'
vaginal examination focusing on atrophy and inflammatory changes, vaginal pH, maturation indices for vaginal and urethral epithelium, urinalyses and cultures, vaginal cultures, serum levels of oestradiol, oestrone, oestrone sulfate

Notes

no useable data; adverse events: 2 women in group A had single episode of vaginal spotting, ˜10% of women had mild breast discomfort
losses to follow up mainly because of illness which resulted in 2 death, group A: 2 at 3/12, + 4 at 6/12, group B: 1 at 3/12 + 4 at 6/12

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

used a table of random numbers

Allocation concealment?

Low risk

A ‐ Adequate, odd and even numbered envelopes kept in the pharmacy
Rufford 2003 S

Methods

Double‐blind RCT, placebo controlled
power calculation
duration of study: 6/12
F/U at 1/12, 3/12 and 6/12

Participants

40 post‐menopausal women
Inclusion criteria: 'urge syndrome', not menstruated for > 12 months or if hysterectomised if oestradiol levels < 150 pmol/L
Exclusion criteria: on medication for 'urge syndrome', diabetes mellitus or insipidus, diuretics, HRT within last 3 months or hormone implant or intramuscular hormone injection within previous year, endometrial thickness > 4 mm or abnormal endometrium on histology, UTI or haematuria, pelvic mass, urogenital prolapse, other contra‐indication to oestrogen therapy
losses to follow up: A: 2, B: 1
Baseline characteristics: BMI A 26.5 (4.3) B 29.0 (6.72); previous hysterectomy A 6 (30%) B 6 (30%); detrusor instability A 7 (35%) B 15 (75%); age at menopause A 46.55, B 47.75 (6.34) years

Interventions

group A (n=20): 17 beta oestradiol 25mg implant subcutaneously
group B (n=20): placebo implant subcutaneously

Outcomes

Outcomes measured by frequency/volume chart, King's Healthcare Quality of Life Questionnaire, urinary symptom questionnaire, visual analogue scale of symptom severity, uroflowmetry, video cystourethrography, serum oestradiol levels, endometrial thickness
definition of cure: complete absence of a symptom that had been present at the beginning of the study
Urgency urinary incontinence not cured: A: 8/15, B: 10/14
Stress incontinence not cured: A: 7/10, B: 5/7
Incontinent episodes in 24 hours (n, mean, SD): A: 16, 2 (5), B: 19, 1 (2)
Number of micturitions in 24 hours (n, mean, SD): A: 16, 9 (3), B: 19, 9 (3)
Adverse effects: A: 5 hysterectomy, 9 irregular vaginal bleeding, 1 angina (was felt not related to study medication), 4 breast tenderness, 8 UTIs
B: 1 breast tenderness, 11 UTIs

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

no description

Blinding?
All outcomes

Low risk

double blind

Incomplete outcome data addressed?
All outcomes

Unclear risk

40 women randomised
Sacco 1990 L

Methods

RCT; duration of study: 90 days

Participants

34 post‐menopausal women
inclusion criteria: USI on urodynamics
exclusion criteria: DO

Interventions

group A (n=17): oestrogen cream 0.5mg
group B (n=17): placebo cream

Outcomes

nocturia, frequency, dysuria, urgency urinary incontinence, pad changes, urodynamics, vaginal dryness, vaginal atrophy

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear, no description

Blinding?
All outcomes

Low risk

outcome assessor and care giver

Incomplete outcome data addressed?
All outcomes

Low risk

no dropouts
Samsioe 1985 #S

Methods

double‐blind placebo‐controlled crossover RCT, sample of previous population study was randomly selected, of these 34 took part in study

Participants

34 post‐menopausal women, 11 with stress incontinence, 14 urgency urinary incontinence, 9 mixed incontinence;
inclusion criteria: women of previous sample with urinary incontinence who lived in catchment area of one of Gothenburg university hospitals; exclusion criteria not stated

Interventions

oestriol 3 mg orally or placebo orally, not clear if each treatment has been given for 3/12 and then was crossed over or if the total duration of both treatments was 3/12

Outcomes

Papanicolau smear to assess percentage of surface cells, MSU, clinical classification of degree of vaginal atrophy, efficacy of bladder control

Notes

no useable data; unclear how many patients had oestrogen first and then placebo or how many had placebo first and the oestrogen; no apparent assessment after each stage of study; methods of assessment not given; no mention of losses to follow up; adverse outcomes: mastodynia, metrorrhagia in 4 patients, subjective side effects

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Tinelli 2007

Methods

randomised controlled trial, openly randomised

Participants

Post‐menopausal women diagnosed with SUI using clinical and urodynamic evaluation

Interventions

48 women randomised to 10mg promestriene as daily suppositories for 21 days before TVT procedure

50 randomised to TVT without preoperative pharmacological therapy

Outcomes

postop clinical evaluation at 3, 6, and 12 months

At 6 months subjective symptom questionnaire and Kings Health Questionnaire

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no mention

Allocation concealment?

High risk

openly randomised

Blinding?
All outcomes

High risk
Tseng 2007

Methods

randomised comparative study

computer‐generated randomization list

Participants

Women with overactive bladder mean age 65.2; range 58‐73, mean parity 2.5; range 1‐5

Interventions

40 women 2mg detrusitol; 40 women 2mg detrusitol and vaginal oestrogen 1gm twice a week for a thee month period

Outcomes

clinical exam, bladder diary, UDI questionnaire assessed at 0,6,12, weeks after treatment

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

computer‐generated randomisation list

Blinding?
All outcomes

High risk
Walter 1978 S

Methods

double‐blind RCT, duration of study 4/12

Participants

29 post‐menopausal women with stress and mixed incontinence, inclusion criteria: postmenopausal, no detrusor hyperreflexia,
neg urine culture

Interventions

group A (n=15): oestradiol 2 mg + oestriol 1 mg orally for 20 days followed by 8 day break for 4/12; group B (n=14): placebo orally similar regime

Outcomes

interview to differentiate between urgency and stress urinary incontinence, cystoscopy, cystometry, MSU, trigone biopsies during cystoscopy, urethra ‐, vagina ‐ and cervix smears, serum levels of oestradiol, cholesterol and triglyceride

Notes

tables using different numbers of patients, unclear how they were classified and who had which sort of incontinence, no losses to follow up, no adverse outcomes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear, no description

Blinding?
All outcomes

Low risk

double blind
Walter 1990 S

Methods

double‐blind placebo‐controlled RCT, randomisation into two treatment groups by block randomisation using random numbers duration of study: 12/52; assessment at 4/52, 8/52, 12/52

Participants

29 post‐menopausal women
inclusion criteria: stress urinary incontinence documented by pad‐weighing test, >1year postmenopausal including iatrogenic menopause, no oestrogen treatment < 2/12 prior to study,patients expected to comply with protocol including treatment on outpatient basis, stable cystometry, no evidence of obstruction
exclusion criteria: neurological disease and senility, diabetes mellitus, liver dysfunction, previous cancer of breast or uterus, hypertension (diastolic > 100 mmHg), concomitant treatment with drugs affecting the lower urinary tract

Interventions

group A (n=15): placebo for 4/52 (period 1), then phenylpropanolamine (PPA) 50mg twice daily + placebo for 4/52 (period 2), then PPA 50mg twice daily + oestriol 4mg daily for 4/52 (period 3)
group B (n=14): placebo for 4/52 (period 1), then oestriol 4mg daily + placebo for 4/52 (period 2), then PPA 50mg twice daily + oestriol 4mg daily for 4/52 (period 3)

Outcomes

subjective drug preference, 3‐day urinary diary, incontinence, median voiding frequency, mean number of leakage episodes, pad test, vaginal cytology, urine cultures, side effects, heart rate, BP

Notes

adverse events: 5 in placebo period, 6 in PPA period, 5 in oestriol period, 7 in PPA + oestriol period
losses to follow up: 1 during PPA period, 1 after period 2 of study (not specified which group)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Low risk

randomisation into two treatment groups by block randomisation using random numbers

Allocation concealment?

Low risk

randomisation into two treatment groups by block randomisation using random numbers

Blinding?
All outcomes

Low risk

women were blind to treatment
Wilson 1987 S

Methods

RCT using statistical tables for random allocation of 2 drugs
duration of study: 12/52, assessment at 6/52 + 11/52

Participants

36 post‐menopausal women
inclusion criteria: serum gonadotrophin in post‐menopausal range, GSI and stable detrusor function on cystourethrography, no HRT in previous 3/12, no contraindications to oestrogen therapy
exclusion criteria: outflow obstruction

6 had hysterectomy

Interventions

group A (n=18): piperazine oestrone sulphate 3mg at night for 3/52 followed by one treatment‐free week
group B (n=18): placebo for 3/52, followed by one treatment‐free week

Outcomes

7 day bladder diary, 2 hour pad test (22 women only), number of micturitions, pad changes/24 hours, urethral pressure profile, vaginal cytology, oestrone, oestradiol, FSH, LH levels, subjective assessment: patients were asked if they were much improved, improved or no better
adverse events: A: 2, 1 palpitations and trembling after 5/7, 1 subendocardial infarct after 5/52 , other adverse events: leg pain, breast discomfort, chest pain, nausea

Notes

losses to follow up: group A: 2 (same women as in adverse events)

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

standard statistical tables for random allocation of two drugs

Blinding?
All outcomes

Low risk

double blind

Incomplete outcome data addressed?
All outcomes

Unclear risk

18 oestrogen group two failed to complete (not included in analysis) 18 placebo group
Zullo 2005 L

Methods

RCT to determine if topical oestrogen therapy can help prevent overactive bladder symptoms after TVT
Duration of study 6 months
Follow up review 1,3 and 6 months after surgery

Participants

56 post‐menopausal women with SUI having a TVT + 3 who were not randomised
inclusion criteria: no periods for last 12 months, serum oestradiol level less than 150pmol/l in patients who have undergone hysterectomy, diagnosis of USI (urodynamic diagnosis), no contraindications to local estrogen therapy, no contraindications to vaginal surgery and informed consent.
exclusion criteria: urogenital prolapse above grade 1, detrusor overactivity, intrinsic urethral sphincter deficiency, previous urogynaecology surgery, endometrial thickness more than 4mm, previous estrogen therapy within past 6 months, unexplained uterine bleeding, or history of diabetes mellitus or insipidus, congestive cardiac failure, diuretic therapy or neoplasms
age (years), mean (SD): A, 56.4 (4.9); B, 55.9 (6.4)
parity: A, 1.8 (0.8); B, 1.6 (0.7)
BMI: A, 26.4 (2.4), B: 25.5 (2.5)
groups comparable on these baseline characteristics
preoperative assessment included TV scan, standardised urogynaecology history clinical examination, urodynamic evaluation. 10 grade VAS, degree of vaginal defects, cough stress test, cotton swab test, pressure flow study, electromyography

Interventions

group A (n=28) intravaginal oestriol ovules (1mg) daily for one month, then 2mg once weekly for 5 months as maintenance therapy
group B (n=28) no oestriol

Outcomes

successful treatment (cure) of SUI was defined as no leakage of urine during the cough stress test and urodynamic test, and no leakage episodes reported in a 7 day voiding diary
Cure of UI: 53/56 (95%) of women cured at 6 months but no data available for each group
UTI in first month after surgery: 4/56 (7%) but no data available for each group
Frequency at 6 months: group A: 2/28, group B: 5/28
Urgency: group A: 1/28,group B: 8/28
No significant increase in endometrial thickness from baseline value in group A, no other adverse effects reported

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

no description

Allocation concealment?

Unclear risk

B ‐ Unclear

Blinding?
All outcomes

Low risk

outcome assessors blind to treatment

Incomplete outcome data addressed?
All outcomes

Low risk

59 had TVT, three women who were eligible after TVT refused to take part. 28 oestrogen group, 28 placebo

BMI = body mass index;
BP = blood pressure;
DO = detrusor overactivity (previously known as DI, detrusor instability);
FSH = follicle stimulating hormone;
HRT = hormone replacement therapy;
ITT = intention to treat;
IU/l = international units per litre;
LH = luteinising hormone;
MSU = midstream specimen of urine;
pH = measure of acidity/alkalinity;
PPA = phenylpropanolamine;
RCT = randomised controlled trial;
SUI = stress urinary incontinence (symptom diagnosis);

UI = urinary incontinence;
USI = urodynamic stress incontinence (previously known as GSI, genuine stress incontinence);
UTI = urinary tract infection;
UUI = urgency urinary incontinence.

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Brandstettter 1961

Unclear if RCT, published in 1961 and in German

Cardozo 1990

Only a paragraph in a review, author contacted for more data, data have never been published, were collected from 1983‐1985, no data available any more

Castillo 1999

Looking at vascular resistance index of periurethral vessels in patients with stress urinary incontinence treated with local oestrogens. No data though 'clinical improvement was found in 15 patients, most of whom received oestrogens'

Ciaccia 2002

Not all women were incontinent at baseline

Ciaccia 2002a

cannot use data, does not state numbers randomised

Foidart 1991

looking at urogenital symptoms and systemic postmenopausal complaints, incontinence only mentioned as part of "Urogenital Index"

Foster 12017

RCT using topical oestrogen cream and biofeedback combinations in four arms. Not all women incontinent at baseline

Howie 1997

Short abstract only, no results given

Kok 1999

All women treated with 2 mg oestradiol, dose finding study of dydrogesterone

Long 2006

RCT but not all women incontinent at baseline

Mikkelsen 1995

Looking at long‐term effect of treatment with oestradiol 3/52 before vaginal repair, only 7 patients with incontinence which is not further specified

Molander 1990

No mention of incontinence, brief description of frequency and urgency only

Nilsson 1994

RCT of transdermal oestrogen versus placebo but for severe urogenital estrogen deficiency (not urinary incontinence)

Notelovitz 1995

67 women with symptoms of urinary urgency, but no comment on cure of urinary symptoms, only pH results given

Palomba 2001

RCT of oestriol cream versus no cream prior to surgery, no outcomes on incontinence. Italian publication

Poreba 1981

RCT with four arms, unclear allocation concealment, not enough usable information given, paper written in Polish

Reid 2004

Not all women were incontinent at baseline. Same study reported in 2005 by Goldstein et al

Rud 1980

RCT but included 6/38 continent women and 9/38 premenopausal women. Outcomes not reported separately

Schmidbauer 1992

Not RCT

Steinauer 2005

Excluded as trial looking at effect of treatment on continent women

Valente 2000

effect of HRT on calcium and collagen, no mention of urinary symptoms

Vardy 2003

RCT but not all patients were incontinent at baseline

Vestergaard 2003

RCT with four arms, two randomised tow patient choice. Excluded as only 70% of women incontinent at baseline

Waetjen 2004

Raloxifene not an oestrogen

Characteristics of ongoing studies [ordered by study ID]

Ir a:

Sant

Trial name or title

A comparative study between oestrogen replacement therapy, anticholinergic treatment and a combination of both in the management of detrusor instability in post‐menopausal women

Methods

Participants

80 participants, 4 random groups
post‐menopausal women, symptoms of detrusor instability, positive cystometry, no contraindications to treatment

Interventions

group A: tolterodine 2mg twice daily
group B: oestrogen 2mg+norethisterone 1mg daily in one tablet
group C: both drugs
group D: placebo

Outcomes

Starting date

Contact information

Notes

tried to contact, no success

Data and analyses

Open in table viewer
Comparison 1. Oestrogen versus placebo or no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence (women's observations) Show forest plot

6

341

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.70, 0.90]
Analysis 1.1
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 1 Number with incontinence (women's observations).

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 1 Number with incontinence (women's observations).

1.1 Systemic administration

4

197

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.70, 0.98]

1.2 Local administration

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.62, 0.87]

2 Number with incontinence not improved (women's observations) Show forest plot

9

444

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.53, 0.72]
Analysis 1.2
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 2 Number with incontinence not improved (women's observations).

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 2 Number with incontinence not improved (women's observations).

2.1 Systemic administration

5

231

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.58, 0.93]

2.2 Local administration

4

213

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.43, 0.65]

3 Incontinence not improved (generic inverse variance) (women's observations) Show forest plot

10

RR (Fixed, 95% CI)

Subtotals only
Analysis 1.3
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 3 Incontinence not improved (generic inverse variance) (women's observations).

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 3 Incontinence not improved (generic inverse variance) (women's observations).

3.1 Systemic administration (any incontinence)

6

6151

RR (Fixed, 95% CI)

1.32 [1.17, 1.48]

3.2 Local administration (any incontinence)

4

213

RR (Fixed, 95% CI)

0.74 [0.64, 0.86]

4 Number with incontinence (objective observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 1.4
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 4 Number with incontinence (objective observations).

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 4 Number with incontinence (objective observations).

4.1 Local administration

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number with incontinence not improved (objective observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.5
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 5 Number with incontinence not improved (objective observations).

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 5 Number with incontinence not improved (objective observations).

5.1 Local administration

2

52

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.40, 0.89]

6 Number of pad changes over 24 hours Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.6
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 6 Number of pad changes over 24 hours.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 6 Number of pad changes over 24 hours.

6.1 Systemic administration

3

112

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.89, 0.66]

7 Pad test weights Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.7
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 7 Pad test weights.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 7 Pad test weights.

7.1 Systemic administration

3

106

Mean Difference (IV, Fixed, 95% CI)

1.75 [‐5.67, 9.16]

8 Incontinent episodes over 24 hours Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.8
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 8 Incontinent episodes over 24 hours.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 8 Incontinent episodes over 24 hours.

8.1 Systemic administration

2

82

Mean Difference (IV, Fixed, 95% CI)

0.54 [‐0.50, 1.57]

9 Number of voids over 24 hours Show forest plot

7

237

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐1.81, ‐0.60]
Analysis 1.9
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 9 Number of voids over 24 hours.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 9 Number of voids over 24 hours.

9.1 Systemic administration

3

125

Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐1.22, 0.73]

9.2 Local administration

4

112

Mean Difference (IV, Fixed, 95% CI)

‐1.80 [‐2.58, ‐1.03]

10 Number of nocturnal voids Show forest plot

5

194

Mean Difference (IV, Fixed, 95% CI)

‐0.33 [‐0.59, ‐0.07]
Analysis 1.10
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 10 Number of nocturnal voids.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 10 Number of nocturnal voids.

10.1 Systemic administration

2

112

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.40, 0.16]

10.2 Local administration

3

82

Mean Difference (IV, Fixed, 95% CI)

‐2.03 [‐2.82, ‐1.24]

11 Number of women with frequency Show forest plot

3

136

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.59, 1.33]
Analysis 1.11
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 11 Number of women with frequency.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 11 Number of women with frequency.

11.1 Systemic administration

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.89, 2.19]

11.2 Local administration

2

90

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.19, 0.98]

12 Number of women with nocturia Show forest plot

2

79

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.55, 1.42]
Analysis 1.12
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 12 Number of women with nocturia.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 12 Number of women with nocturia.

12.1 Systemic administration

1

45

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.62, 1.62]

12.2 Local administration

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.11, 2.38]

13 Number of women with urgency Show forest plot

4

179

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.67, 1.12]
Analysis 1.13
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 13 Number of women with urgency.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 13 Number of women with urgency.

13.1 Systemic administration

2

89

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.83, 1.33]

13.2 Local administration

2

90

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.15, 0.99]

14 Maximum urethral closure pressure (MUCP) Show forest plot

7

291

Mean Difference (IV, Fixed, 95% CI)

3.61 [1.87, 5.35]
Analysis 1.14
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 14 Maximum urethral closure pressure (MUCP).

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 14 Maximum urethral closure pressure (MUCP).

14.1 Systemic administration

2

89

Mean Difference (IV, Fixed, 95% CI)

‐1.41 [‐6.24, 3.43]

14.2 Local administration

5

202

Mean Difference (IV, Fixed, 95% CI)

4.35 [2.49, 6.22]

15 Volume at first urge to void Show forest plot

7

269

Mean Difference (IV, Fixed, 95% CI)

18.80 [13.01, 24.60]
Analysis 1.15
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 15 Volume at first urge to void.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 15 Volume at first urge to void.

15.1 Systemic administration

3

153

Mean Difference (IV, Fixed, 95% CI)

9.09 [‐25.45, 43.62]

15.2 Local administration

4

116

Mean Difference (IV, Fixed, 95% CI)

19.09 [13.21, 24.96]

16 Maximum bladder capacity Show forest plot

7

269

Mean Difference (IV, Fixed, 95% CI)

45.34 [31.86, 58.82]
Analysis 1.16
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 16 Maximum bladder capacity.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 16 Maximum bladder capacity.

16.1 Systemic administration

3

153

Mean Difference (IV, Fixed, 95% CI)

7.18 [‐33.26, 47.62]

16.2 Local administration

4

116

Mean Difference (IV, Fixed, 95% CI)

50.11 [35.81, 64.41]

17 Number with adverse effects Show forest plot

3

184

Risk Ratio (M‐H, Fixed, 95% CI)

4.25 [1.50, 12.03]
Analysis 1.17
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 17 Number with adverse effects.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 17 Number with adverse effects.

17.1 Systemic administration

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

13.0 [1.87, 90.21]

17.2 Local administration

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.32, 5.61]

18 Number with bacteriuria Show forest plot

2

128

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.27, 0.76]
Analysis 1.18
Comparison 1 Oestrogen versus placebo or no treatment, Outcome 18 Number with bacteriuria.

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 18 Number with bacteriuria.

18.1 Systemic administration

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.37, 1.42]

18.2 Local administration

1

88

Risk Ratio (M‐H, Fixed, 95% CI)

0.3 [0.13, 0.68]
Open in table viewer
Comparison 2. Oestrogen versus other treatments

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 2.1
Comparison 2 Oestrogen versus other treatments, Outcome 1 Number with incontinence (women's observations).

Comparison 2 Oestrogen versus other treatments, Outcome 1 Number with incontinence (women's observations).

1.1 oestrogen vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number with incontinence, crossover studies (women's observations) Show forest plot

Other data

No numeric data
Analysis 2.2

Study

Oestrogen

PPA

Oetrogens versus PPA

Beisland 1984#L

9/10 women

10/10 women

Comparison 2 Oestrogen versus other treatments, Outcome 2 Number with incontinence, crossover studies (women's observations).

2.1 Oetrogens versus PPA

Other data

No numeric data

3 Number with incontinence not improved (women's observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 2.3
Comparison 2 Oestrogen versus other treatments, Outcome 3 Number with incontinence not improved (women's observations).

Comparison 2 Oestrogen versus other treatments, Outcome 3 Number with incontinence not improved (women's observations).

3.1 oestrogen vs PPA

2

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.63, 1.09]

4 Number with incontinence not improved, crossover studies (women's observations) Show forest plot

Other data

No numeric data
Analysis 2.4

Study

Oestrogen

PPA

Oetrogens versus PPA

Beisland 1984#L

6/10 women

2/10 women

Comparison 2 Oestrogen versus other treatments, Outcome 4 Number with incontinence not improved, crossover studies (women's observations).

4.1 Oetrogens versus PPA

Other data

No numeric data

5 Number with incontinence (objective observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 2.5
Comparison 2 Oestrogen versus other treatments, Outcome 5 Number with incontinence (objective observations).

Comparison 2 Oestrogen versus other treatments, Outcome 5 Number with incontinence (objective observations).

5.1 oestrogen vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number with incontinence not improved (objective observations) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 2.6
Comparison 2 Oestrogen versus other treatments, Outcome 6 Number with incontinence not improved (objective observations).

Comparison 2 Oestrogen versus other treatments, Outcome 6 Number with incontinence not improved (objective observations).

6.1 oestrogen vs PPA

1

29

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.46, 1.90]

6.2 oestrogen vs PFMT

2

69

Risk Ratio (M‐H, Fixed, 95% CI)

1.62 [1.18, 2.23]

6.3 oestrogen vs electrostimulation

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.95, 1.75]

7 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 2.7
Comparison 2 Oestrogen versus other treatments, Outcome 7 Number of pad changes over 24 hours.

Comparison 2 Oestrogen versus other treatments, Outcome 7 Number of pad changes over 24 hours.

7.1 oestrogen vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of voids over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 2.8
Comparison 2 Oestrogen versus other treatments, Outcome 8 Number of voids over 24 hours.

Comparison 2 Oestrogen versus other treatments, Outcome 8 Number of voids over 24 hours.

8.1 oestrogen vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 2.9
Comparison 2 Oestrogen versus other treatments, Outcome 9 Pad test weights.

Comparison 2 Oestrogen versus other treatments, Outcome 9 Pad test weights.

9.1 oestrogen vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Adverse effects Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 2.10
Comparison 2 Oestrogen versus other treatments, Outcome 10 Adverse effects.

Comparison 2 Oestrogen versus other treatments, Outcome 10 Adverse effects.

10.1 oestrogen vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Maximum urethral closure pressure (MUCP) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 2.11
Comparison 2 Oestrogen versus other treatments, Outcome 11 Maximum urethral closure pressure (MUCP).

Comparison 2 Oestrogen versus other treatments, Outcome 11 Maximum urethral closure pressure (MUCP).

11.1 oestrogen vs PFMT

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 oestrogen vs electrostimulation

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Maximum urethral closure pressure (MUCP), crossover studies Show forest plot

Other data

No numeric data
Analysis 2.12

Study

Oestrogen

PPA

Oetrogens versus PPA

Beisland 1984#L

Mean=41.6, N=10

Mean=47.1, N=10

Comparison 2 Oestrogen versus other treatments, Outcome 12 Maximum urethral closure pressure (MUCP), crossover studies.

12.1 Oetrogens versus PPA

Other data

No numeric data
Open in table viewer
Comparison 3. Oestrogen + other treatments versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence not improved (women's observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 3.1
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 1 Number with incontinence not improved (women's observations).

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 1 Number with incontinence not improved (women's observations).

1.1 oestrogen + progesterone vs placebo

2

1514

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [1.01, 1.16]

2 Incontinence not improved (generic inverse variance) (women's observations) Show forest plot

3

Relative Risk (Fixed, 95% CI)

Subtotals only
Analysis 3.2
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 2 Incontinence not improved (generic inverse variance) (women's observations).

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 2 Incontinence not improved (generic inverse variance) (women's observations).

2.1 Systemic administration of oestrogen + progesterone vs placebo

3

10635

Relative Risk (Fixed, 95% CI)

1.11 [1.04, 1.18]

3 Incontinent episodes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 3.3
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 3 Incontinent episodes over 24 hours.

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 3 Incontinent episodes over 24 hours.

3.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of diurnal voids per 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 3.4
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 4 Number of diurnal voids per 24 hours.

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 4 Number of diurnal voids per 24 hours.

4.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number of nocturnal voids per 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 3.5
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 5 Number of nocturnal voids per 24 hours.

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 5 Number of nocturnal voids per 24 hours.

5.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 3.6
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 6 Pad test weights.

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 6 Pad test weights.

6.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Use of drugs for incontinence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 3.7
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 7 Use of drugs for incontinence.

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 7 Use of drugs for incontinence.

7.1 oestrogen + progesterone vs placebo

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of women having incontinence surgery Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 3.8
Comparison 3 Oestrogen + other treatments versus placebo, Outcome 8 Number of women having incontinence surgery.

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 8 Number of women having incontinence surgery.

8.1 oestrogen + progesterone vs placebo

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Open in table viewer
Comparison 4. Oestrogen + other treatments versus oestrogen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence not improved (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 4.1
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 1 Number with incontinence not improved (women's observations).

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 1 Number with incontinence not improved (women's observations).

1.1 Oestrogen + PPA vs oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number with incontinence not improved (women's observations) (cross‐over trials) Show forest plot

Other data

No numeric data
Analysis 4.2

Study

oestr + other drug

oestrogen

oestrogen + PPA vs oestrogen

Ahlstrom 1990#S

17/27

21/26

Kinn 1988#S

14/30

21/30

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 2 Number with incontinence not improved (women's observations) (cross‐over trials).

2.1 oestrogen + PPA vs oestrogen

Other data

No numeric data

3 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 4.3
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 3 Number of pad changes over 24 hours.

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 3 Number of pad changes over 24 hours.

3.1 oestrogen + PPA vs oestrogen

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of voids over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 4.4
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 4 Number of voids over 24 hours.

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 4 Number of voids over 24 hours.

4.1 oestrogen + PPA vs oestrogen

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 4.5
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 5 Pad test weights.

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 5 Pad test weights.

5.1 oestrogen + PPA vs oestrogen

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number of women with frequency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 4.6
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 6 Number of women with frequency.

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 6 Number of women with frequency.

6.1 oestrogen + progesterone vs oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 oestriol + benzidamine vs oestriol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Number of women with nocturia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 4.7
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 7 Number of women with nocturia.

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 7 Number of women with nocturia.

7.1 oestriol + benzidamine vs oestriol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number with adverse effects Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 4.8
Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 8 Number with adverse effects.

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 8 Number with adverse effects.

8.1 Oestrogen + PPA vs oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Volume at first urge to void (cross‐over trials) Show forest plot

Other data

No numeric data
Analysis 4.9

Study

oestrogen + naproxen

oestrogen

oestrogen + PPA vs oestrogen

Blom 1995#S

172 ml (SD 12) N=16

186 ml (SD 12) N=16

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 9 Volume at first urge to void (cross‐over trials).

9.1 oestrogen + PPA vs oestrogen

Other data

No numeric data

10 Maximum bladder capacity (cross‐over trials) Show forest plot

Other data

No numeric data
Analysis 4.10

Study

oestr + naproxen

oestrogen

oestrogen +other vs oestrogen

Blom 1995#S

316 ml (SD 17) N=16

318 ml (SD 20) N=16

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 10 Maximum bladder capacity (cross‐over trials).

10.1 oestrogen +other vs oestrogen

Other data

No numeric data
Open in table viewer
Comparison 5. Oestrogen + other treatments versus other treatments

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence (women's observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 5.1
Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 1 Number with incontinence (women's observations).

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 1 Number with incontinence (women's observations).

1.1 oestrogen + PFMT vs PFMT

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 TVT vs TVT + vaginal oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number with incontinence not improved (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 5.2
Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 2 Number with incontinence not improved (women's observations).

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 2 Number with incontinence not improved (women's observations).

2.1 oestrogen + PPA vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 5.3
Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 3 Number of pad changes over 24 hours.

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 3 Number of pad changes over 24 hours.

3.1 oestrogen + PPA vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of voids over 24 hours Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 5.4
Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 4 Number of voids over 24 hours.

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 4 Number of voids over 24 hours.

4.1 oestrogen + PPA vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 detrusitol + vaginal oestrogen vs detrusitol m

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 5.5
Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 5 Pad test weights.

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 5 Pad test weights.

5.1 oestrogen + PPA vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Adverse effects Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 5.6
Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 6 Adverse effects.

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 6 Adverse effects.

6.1 oestrogen + PPA vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 oestrogen + PFMT vs PFMT

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Open in table viewer
Comparison 6. Different types of oestrogen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence not improved (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 6.1
Comparison 6 Different types of oestrogen, Outcome 1 Number with incontinence not improved (women's observations).

Comparison 6 Different types of oestrogen, Outcome 1 Number with incontinence not improved (women's observations).

1.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of women with nocturia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 6.2
Comparison 6 Different types of oestrogen, Outcome 2 Number of women with nocturia.

Comparison 6 Different types of oestrogen, Outcome 2 Number of women with nocturia.

2.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of women with dysuria Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 6.3
Comparison 6 Different types of oestrogen, Outcome 3 Number of women with dysuria.

Comparison 6 Different types of oestrogen, Outcome 3 Number of women with dysuria.

3.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of women with urgency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 6.4
Comparison 6 Different types of oestrogen, Outcome 4 Number of women with urgency.

Comparison 6 Different types of oestrogen, Outcome 4 Number of women with urgency.

4.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 oestrogen cream vs vaginal oestrogen + progesterone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number of women with frequency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 6.5
Comparison 6 Different types of oestrogen, Outcome 5 Number of women with frequency.

Comparison 6 Different types of oestrogen, Outcome 5 Number of women with frequency.

5.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 oestrogen cream vs vaginal oestrogen + progesterone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number of adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Analysis 6.6
Comparison 6 Different types of oestrogen, Outcome 6 Number of adverse events.

Comparison 6 Different types of oestrogen, Outcome 6 Number of adverse events.

6.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Open in table viewer
Comparison 7. Different routes of administration

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 7.1
Comparison 7 Different routes of administration, Outcome 1 Number of pad changes over 24 hours.

Comparison 7 Different routes of administration, Outcome 1 Number of pad changes over 24 hours.

1.1 oestrogen cream vs oestrogen orally

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of voids over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 7.2
Comparison 7 Different routes of administration, Outcome 2 Number of voids over 24 hours.

Comparison 7 Different routes of administration, Outcome 2 Number of voids over 24 hours.

2.1 oestrogen cream vs oestrogen orally

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Analysis 7.3
Comparison 7 Different routes of administration, Outcome 3 Pad test weights.

Comparison 7 Different routes of administration, Outcome 3 Pad test weights.

3.1 oestrogen cream vs oestrogen orally

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Open in table viewer
Comparison 8. High‐dose versus low‐dose oestrogen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of voids over 24 hours Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 8.1
Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 1 Number of voids over 24 hours.

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 1 Number of voids over 24 hours.

1.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

‐1.02 [‐1.87, ‐0.16]

2 Number of nocturnal voids Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 8.2
Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 2 Number of nocturnal voids.

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 2 Number of nocturnal voids.

2.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

‐1.80 [‐2.36, ‐1.24]

3 Maximum urethral closure pressure (MUCP) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 8.3
Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 3 Maximum urethral closure pressure (MUCP).

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 3 Maximum urethral closure pressure (MUCP).

3.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

3.84 [‐5.77, 13.46]

4 Volume at first urge to void Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 8.4
Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 4 Volume at first urge to void.

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 4 Volume at first urge to void.

4.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

‐1.56 [‐12.20, 9.08]

5 Maximum bladder capacity Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 8.5
Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 5 Maximum bladder capacity.

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 5 Maximum bladder capacity.

5.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

34.90 [8.35, 61.45]

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 1 Number with incontinence (women's observations).
Figuras y tablas -
Analysis 1.1

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 1 Number with incontinence (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 2 Number with incontinence not improved (women's observations).
Figuras y tablas -
Analysis 1.2

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 2 Number with incontinence not improved (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 3 Incontinence not improved (generic inverse variance) (women's observations).
Figuras y tablas -
Analysis 1.3

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 3 Incontinence not improved (generic inverse variance) (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 4 Number with incontinence (objective observations).
Figuras y tablas -
Analysis 1.4

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 4 Number with incontinence (objective observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 5 Number with incontinence not improved (objective observations).
Figuras y tablas -
Analysis 1.5

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 5 Number with incontinence not improved (objective observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 6 Number of pad changes over 24 hours.
Figuras y tablas -
Analysis 1.6

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 6 Number of pad changes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 7 Pad test weights.
Figuras y tablas -
Analysis 1.7

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 7 Pad test weights.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 8 Incontinent episodes over 24 hours.
Figuras y tablas -
Analysis 1.8

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 8 Incontinent episodes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 9 Number of voids over 24 hours.
Figuras y tablas -
Analysis 1.9

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 9 Number of voids over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 10 Number of nocturnal voids.
Figuras y tablas -
Analysis 1.10

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 10 Number of nocturnal voids.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 11 Number of women with frequency.
Figuras y tablas -
Analysis 1.11

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 11 Number of women with frequency.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 12 Number of women with nocturia.
Figuras y tablas -
Analysis 1.12

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 12 Number of women with nocturia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 13 Number of women with urgency.
Figuras y tablas -
Analysis 1.13

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 13 Number of women with urgency.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 14 Maximum urethral closure pressure (MUCP).
Figuras y tablas -
Analysis 1.14

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 14 Maximum urethral closure pressure (MUCP).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 15 Volume at first urge to void.
Figuras y tablas -
Analysis 1.15

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 15 Volume at first urge to void.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 16 Maximum bladder capacity.
Figuras y tablas -
Analysis 1.16

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 16 Maximum bladder capacity.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 17 Number with adverse effects.
Figuras y tablas -
Analysis 1.17

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 17 Number with adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 18 Number with bacteriuria.
Figuras y tablas -
Analysis 1.18

Comparison 1 Oestrogen versus placebo or no treatment, Outcome 18 Number with bacteriuria.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 1 Number with incontinence (women's observations).
Figuras y tablas -
Analysis 2.1

Comparison 2 Oestrogen versus other treatments, Outcome 1 Number with incontinence (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study

Oestrogen

PPA

Oetrogens versus PPA

Beisland 1984#L

9/10 women

10/10 women

Figuras y tablas -
Analysis 2.2

Comparison 2 Oestrogen versus other treatments, Outcome 2 Number with incontinence, crossover studies (women's observations).

Ir a la figura de la revisión

Comparison 2 Oestrogen versus other treatments, Outcome 3 Number with incontinence not improved (women's observations).
Figuras y tablas -
Analysis 2.3

Comparison 2 Oestrogen versus other treatments, Outcome 3 Number with incontinence not improved (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study

Oestrogen

PPA

Oetrogens versus PPA

Beisland 1984#L

6/10 women

2/10 women

Figuras y tablas -
Analysis 2.4

Comparison 2 Oestrogen versus other treatments, Outcome 4 Number with incontinence not improved, crossover studies (women's observations).

Ir a la figura de la revisión

Comparison 2 Oestrogen versus other treatments, Outcome 5 Number with incontinence (objective observations).
Figuras y tablas -
Analysis 2.5

Comparison 2 Oestrogen versus other treatments, Outcome 5 Number with incontinence (objective observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 6 Number with incontinence not improved (objective observations).
Figuras y tablas -
Analysis 2.6

Comparison 2 Oestrogen versus other treatments, Outcome 6 Number with incontinence not improved (objective observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 7 Number of pad changes over 24 hours.
Figuras y tablas -
Analysis 2.7

Comparison 2 Oestrogen versus other treatments, Outcome 7 Number of pad changes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 8 Number of voids over 24 hours.
Figuras y tablas -
Analysis 2.8

Comparison 2 Oestrogen versus other treatments, Outcome 8 Number of voids over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 9 Pad test weights.
Figuras y tablas -
Analysis 2.9

Comparison 2 Oestrogen versus other treatments, Outcome 9 Pad test weights.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 10 Adverse effects.
Figuras y tablas -
Analysis 2.10

Comparison 2 Oestrogen versus other treatments, Outcome 10 Adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Oestrogen versus other treatments, Outcome 11 Maximum urethral closure pressure (MUCP).
Figuras y tablas -
Analysis 2.11

Comparison 2 Oestrogen versus other treatments, Outcome 11 Maximum urethral closure pressure (MUCP).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study

Oestrogen

PPA

Oetrogens versus PPA

Beisland 1984#L

Mean=41.6, N=10

Mean=47.1, N=10

Figuras y tablas -
Analysis 2.12

Comparison 2 Oestrogen versus other treatments, Outcome 12 Maximum urethral closure pressure (MUCP), crossover studies.

Ir a la figura de la revisión

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 1 Number with incontinence not improved (women's observations).
Figuras y tablas -
Analysis 3.1

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 1 Number with incontinence not improved (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 2 Incontinence not improved (generic inverse variance) (women's observations).
Figuras y tablas -
Analysis 3.2

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 2 Incontinence not improved (generic inverse variance) (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 3 Incontinent episodes over 24 hours.
Figuras y tablas -
Analysis 3.3

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 3 Incontinent episodes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 4 Number of diurnal voids per 24 hours.
Figuras y tablas -
Analysis 3.4

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 4 Number of diurnal voids per 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 5 Number of nocturnal voids per 24 hours.
Figuras y tablas -
Analysis 3.5

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 5 Number of nocturnal voids per 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 6 Pad test weights.
Figuras y tablas -
Analysis 3.6

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 6 Pad test weights.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 7 Use of drugs for incontinence.
Figuras y tablas -
Analysis 3.7

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 7 Use of drugs for incontinence.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 8 Number of women having incontinence surgery.
Figuras y tablas -
Analysis 3.8

Comparison 3 Oestrogen + other treatments versus placebo, Outcome 8 Number of women having incontinence surgery.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 1 Number with incontinence not improved (women's observations).
Figuras y tablas -
Analysis 4.1

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 1 Number with incontinence not improved (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study

oestr + other drug

oestrogen

oestrogen + PPA vs oestrogen

Ahlstrom 1990#S

17/27

21/26

Kinn 1988#S

14/30

21/30

Figuras y tablas -
Analysis 4.2

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 2 Number with incontinence not improved (women's observations) (cross‐over trials).

Ir a la figura de la revisión

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 3 Number of pad changes over 24 hours.
Figuras y tablas -
Analysis 4.3

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 3 Number of pad changes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 4 Number of voids over 24 hours.
Figuras y tablas -
Analysis 4.4

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 4 Number of voids over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 5 Pad test weights.
Figuras y tablas -
Analysis 4.5

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 5 Pad test weights.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 6 Number of women with frequency.
Figuras y tablas -
Analysis 4.6

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 6 Number of women with frequency.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 7 Number of women with nocturia.
Figuras y tablas -
Analysis 4.7

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 7 Number of women with nocturia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 8 Number with adverse effects.
Figuras y tablas -
Analysis 4.8

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 8 Number with adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study

oestrogen + naproxen

oestrogen

oestrogen + PPA vs oestrogen

Blom 1995#S

172 ml (SD 12) N=16

186 ml (SD 12) N=16

Figuras y tablas -
Analysis 4.9

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 9 Volume at first urge to void (cross‐over trials).

Ir a la figura de la revisión

Study

oestr + naproxen

oestrogen

oestrogen +other vs oestrogen

Blom 1995#S

316 ml (SD 17) N=16

318 ml (SD 20) N=16

Figuras y tablas -
Analysis 4.10

Comparison 4 Oestrogen + other treatments versus oestrogen, Outcome 10 Maximum bladder capacity (cross‐over trials).

Ir a la figura de la revisión

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 1 Number with incontinence (women's observations).
Figuras y tablas -
Analysis 5.1

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 1 Number with incontinence (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 2 Number with incontinence not improved (women's observations).
Figuras y tablas -
Analysis 5.2

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 2 Number with incontinence not improved (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 3 Number of pad changes over 24 hours.
Figuras y tablas -
Analysis 5.3

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 3 Number of pad changes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 4 Number of voids over 24 hours.
Figuras y tablas -
Analysis 5.4

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 4 Number of voids over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 5 Pad test weights.
Figuras y tablas -
Analysis 5.5

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 5 Pad test weights.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 6 Adverse effects.
Figuras y tablas -
Analysis 5.6

Comparison 5 Oestrogen + other treatments versus other treatments, Outcome 6 Adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Different types of oestrogen, Outcome 1 Number with incontinence not improved (women's observations).
Figuras y tablas -
Analysis 6.1

Comparison 6 Different types of oestrogen, Outcome 1 Number with incontinence not improved (women's observations).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Different types of oestrogen, Outcome 2 Number of women with nocturia.
Figuras y tablas -
Analysis 6.2

Comparison 6 Different types of oestrogen, Outcome 2 Number of women with nocturia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Different types of oestrogen, Outcome 3 Number of women with dysuria.
Figuras y tablas -
Analysis 6.3

Comparison 6 Different types of oestrogen, Outcome 3 Number of women with dysuria.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Different types of oestrogen, Outcome 4 Number of women with urgency.
Figuras y tablas -
Analysis 6.4

Comparison 6 Different types of oestrogen, Outcome 4 Number of women with urgency.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Different types of oestrogen, Outcome 5 Number of women with frequency.
Figuras y tablas -
Analysis 6.5

Comparison 6 Different types of oestrogen, Outcome 5 Number of women with frequency.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 6 Different types of oestrogen, Outcome 6 Number of adverse events.
Figuras y tablas -
Analysis 6.6

Comparison 6 Different types of oestrogen, Outcome 6 Number of adverse events.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 7 Different routes of administration, Outcome 1 Number of pad changes over 24 hours.
Figuras y tablas -
Analysis 7.1

Comparison 7 Different routes of administration, Outcome 1 Number of pad changes over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 7 Different routes of administration, Outcome 2 Number of voids over 24 hours.
Figuras y tablas -
Analysis 7.2

Comparison 7 Different routes of administration, Outcome 2 Number of voids over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 7 Different routes of administration, Outcome 3 Pad test weights.
Figuras y tablas -
Analysis 7.3

Comparison 7 Different routes of administration, Outcome 3 Pad test weights.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 1 Number of voids over 24 hours.
Figuras y tablas -
Analysis 8.1

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 1 Number of voids over 24 hours.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 2 Number of nocturnal voids.
Figuras y tablas -
Analysis 8.2

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 2 Number of nocturnal voids.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 3 Maximum urethral closure pressure (MUCP).
Figuras y tablas -
Analysis 8.3

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 3 Maximum urethral closure pressure (MUCP).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 4 Volume at first urge to void.
Figuras y tablas -
Analysis 8.4

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 4 Volume at first urge to void.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 5 Maximum bladder capacity.
Figuras y tablas -
Analysis 8.5

Comparison 8 High‐dose versus low‐dose oestrogen, Outcome 5 Maximum bladder capacity.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Table 1. Summary of study characteristics: type of oestrogen, route of administration, dose, length of treatment, population

Study ID

Type of Oestrogen

Route of administration

Dose

Length of treatment

Population

Ahlstrom 1990#S

Oestriol

Systemic (oral)

4mg

6 weeks

USI (stress), postmenopausal

Beisland 1984#L

Oestriol

Local (vaginal)

1 mg

8 weeks

UI (stress), postmenopausal

Blom 1995#S

Estradiol

Systemic (transdermal)

0.05 mg

8 weeks

UUI (OAB), elderly

Cardozo 1993 S

Oestriol

Systemic (oral)

3 mg

3 months

UUI (urge), postmenopausal

Cardozo 2001 L

Oestradiol

Vaginal (pessary, Vagifem)

25 µgm

3 months

OAB (urge), postmenopausal

Chompootaweep 1998 SL

A: Ethinyl oestradiol + levonorgestrel

B: conjugated equine oestrogen

A: Systemic (oral)

B: Local (vaginal cream)

A: 30 mg /250 ng

B: 0.625 mg

2 months

UUI (urogenital symptoms), oestrogen deficiency, postmenopausal

Dessole 2004 L

Oestriol

Local (intravaginal ovules)

1‐2 mg

6 months

UI (stress), postmenopausal

Ek 1980#S

Oestradiol

Systemic (oral)

1 mg

6 weeks

USI (stress), postmenopausal

Enzelsberger 1990 L

Oestriol

Local (vaginal)

0.5, 1 or 2 mg

Not stated

UI (urge), OAB

Enzelsberger 1991a L; Enzelsberger 1991b L

Oestriol

Local (vaginal)

1 mg or 3 mg

3 weeks

UI (urge), OAB, postmenopausal

Fantl 1996 S

Conjugated equine oestrogens + medroxyprogesterone

Systemic (oral)

0.625 mg / 10 mg

3 months

UI (stress), postmenopausal

Grady 2001 S

Conjugated oestrogens (premarin) + medroxyprogesterone

Systemic (oral)

0.625 mg / 2.5 mg

up to 4 years

UI (unspecified), postmenopausal, heart disease, age <80 years, with uterus

Henalla 1989 L

Conjugated equine oestrogen

Local (vaginal cream)

1.25 mg

3 months

USI (stress)

Henalla 1990 L

Conjugated equine oestrogen

Local (vaginal cream)

2 gm

6 weeks

USI (stress), postmenopausal

HendrixA (no uterus) S

Conjugated equine oestrogen

Systemic (oral)

0.625 mg

1 year

UI (SUI, UUI, MUI), postmenopausal, prevention of heart disease and hip fracture

Without uterus

HendrixB (+ uterus) S

Conjugated equine oestrogen + medroxyprogesterone

Systemic (oral)

0.625 mg / 2.5 mg

1 year

UI (SUI, UUI, MUI), postmenopausal, prevention of heart disease and hip fracture

With uterus

Hilton 1990 SL

Oestrogen

Local (intravaginal)

Systemic (oral)

2 gm

1.25 mg

1 month

USI (stress), postmenopausal

Ishiko 2001 S

Estriol

Systemic (oral)

1 mg

2 years

SUI (stress), postmenopausal

Jackson 1999 S

Oestradiol

Systemic (oral)

2 mg

6 months

USI (stress), postmenopausal

Judge 1969#

Quinestradiol

Not stated

1 mg

1 month

UI (unspecified), postmenopausal, geriatric inpatients

Kinn 1988#S

Oestriol

Systemic (oral)

4 mg

1 month

USI (stress), postmenopausal

Kurz 1993 L

Oestriol

Local (intravesical)

1 mg

3 weeks

UUI, OAB (urge), postmenopausal

Lose 2000 L

Oestradiol

Local (intravaginal ring, vaginal pessaries)

ring 7.5mg, pessary 0.5 mg

6 months

UI (unspecified), LUT symptoms, postmenopausal

Melis 1997 L

Oestriol

Local (intravaginal)

0.5 mg

3 months

UI, menopausal symptoms

Ouslander 2001 S

Oestrogen + progesterone

Systemic (oral)

0.625 mg / 2.5 mg

6 months

UI (unspecified), nursing home residents

Rufford 2003 S

17‐beta oestradiol

Systemic (implant)

25 mg

6 months

UUI, OAB (urge), postmenopausal

Sacco 1990 L

Oestrogen

Local (cream)

0.5 mg

3 months

USI (stress), postmenopausal

Samsioe 1985 #S

Oestriol

Systemic (oral)

3 mg

3 months

MUI (mixture), postmenopausal

Walter 1978 S

Oestradiol + oestriol

Systemic (oral)

2 mg / 1 mg

4 months (with breaks)

SUI, MUI (stress and mixed), postmenopausal

Walter 1990 S

Oestriol

Systemic (oral)

4 mg

1‐2 months

SUI (stress), postmenopausal

Wilson 1987 S

Piperazine oestrone sulphate

Systemic (oral)

3 mg

3 months (with breaks)

USI (stress), postmenopausal

Zullo 2005 L

Estriol

Local (intravaginal ovules)

1 mg

6 months

SUI (stress), postmenopausal

LUTs = lower urinary tract symptoms; MUI = mixed urinary incontinence; OAB = overactive bladder syndrome; SUI = stress urinary incontinence; UI = urinary incontinence; USI = urodynamic stress incontinence; UUI = urgency urinary incontinence.

Figuras y tablas -
Table 1. Summary of study characteristics: type of oestrogen, route of administration, dose, length of treatment, population
Ir a la tabla de la revisión
Comparison 1. Oestrogen versus placebo or no treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence (women's observations) Show forest plot

6

341

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.70, 0.90]

1.1 Systemic administration

4

197

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.70, 0.98]

1.2 Local administration

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.62, 0.87]

2 Number with incontinence not improved (women's observations) Show forest plot

9

444

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.53, 0.72]

2.1 Systemic administration

5

231

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.58, 0.93]

2.2 Local administration

4

213

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.43, 0.65]

3 Incontinence not improved (generic inverse variance) (women's observations) Show forest plot

10

RR (Fixed, 95% CI)

Subtotals only

3.1 Systemic administration (any incontinence)

6

6151

RR (Fixed, 95% CI)

1.32 [1.17, 1.48]

3.2 Local administration (any incontinence)

4

213

RR (Fixed, 95% CI)

0.74 [0.64, 0.86]

4 Number with incontinence (objective observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Local administration

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number with incontinence not improved (objective observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Local administration

2

52

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.40, 0.89]

6 Number of pad changes over 24 hours Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Systemic administration

3

112

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.89, 0.66]

7 Pad test weights Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Systemic administration

3

106

Mean Difference (IV, Fixed, 95% CI)

1.75 [‐5.67, 9.16]

8 Incontinent episodes over 24 hours Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Systemic administration

2

82

Mean Difference (IV, Fixed, 95% CI)

0.54 [‐0.50, 1.57]

9 Number of voids over 24 hours Show forest plot

7

237

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐1.81, ‐0.60]

9.1 Systemic administration

3

125

Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐1.22, 0.73]

9.2 Local administration

4

112

Mean Difference (IV, Fixed, 95% CI)

‐1.80 [‐2.58, ‐1.03]

10 Number of nocturnal voids Show forest plot

5

194

Mean Difference (IV, Fixed, 95% CI)

‐0.33 [‐0.59, ‐0.07]

10.1 Systemic administration

2

112

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.40, 0.16]

10.2 Local administration

3

82

Mean Difference (IV, Fixed, 95% CI)

‐2.03 [‐2.82, ‐1.24]

11 Number of women with frequency Show forest plot

3

136

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.59, 1.33]

11.1 Systemic administration

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.89, 2.19]

11.2 Local administration

2

90

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.19, 0.98]

12 Number of women with nocturia Show forest plot

2

79

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.55, 1.42]

12.1 Systemic administration

1

45

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.62, 1.62]

12.2 Local administration

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.11, 2.38]

13 Number of women with urgency Show forest plot

4

179

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.67, 1.12]

13.1 Systemic administration

2

89

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.83, 1.33]

13.2 Local administration

2

90

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.15, 0.99]

14 Maximum urethral closure pressure (MUCP) Show forest plot

7

291

Mean Difference (IV, Fixed, 95% CI)

3.61 [1.87, 5.35]

14.1 Systemic administration

2

89

Mean Difference (IV, Fixed, 95% CI)

‐1.41 [‐6.24, 3.43]

14.2 Local administration

5

202

Mean Difference (IV, Fixed, 95% CI)

4.35 [2.49, 6.22]

15 Volume at first urge to void Show forest plot

7

269

Mean Difference (IV, Fixed, 95% CI)

18.80 [13.01, 24.60]

15.1 Systemic administration

3

153

Mean Difference (IV, Fixed, 95% CI)

9.09 [‐25.45, 43.62]

15.2 Local administration

4

116

Mean Difference (IV, Fixed, 95% CI)

19.09 [13.21, 24.96]

16 Maximum bladder capacity Show forest plot

7

269

Mean Difference (IV, Fixed, 95% CI)

45.34 [31.86, 58.82]

16.1 Systemic administration

3

153

Mean Difference (IV, Fixed, 95% CI)

7.18 [‐33.26, 47.62]

16.2 Local administration

4

116

Mean Difference (IV, Fixed, 95% CI)

50.11 [35.81, 64.41]

17 Number with adverse effects Show forest plot

3

184

Risk Ratio (M‐H, Fixed, 95% CI)

4.25 [1.50, 12.03]

17.1 Systemic administration

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

13.0 [1.87, 90.21]

17.2 Local administration

2

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.32, 5.61]

18 Number with bacteriuria Show forest plot

2

128

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.27, 0.76]

18.1 Systemic administration

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.37, 1.42]

18.2 Local administration

1

88

Risk Ratio (M‐H, Fixed, 95% CI)

0.3 [0.13, 0.68]
Figuras y tablas -
Comparison 1. Oestrogen versus placebo or no treatment
Ir a la tabla de la revisión
Comparison 2. Oestrogen versus other treatments

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 oestrogen vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number with incontinence, crossover studies (women's observations) Show forest plot

Other data

No numeric data

2.1 Oetrogens versus PPA

Other data

No numeric data

3 Number with incontinence not improved (women's observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 oestrogen vs PPA

2

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.63, 1.09]

4 Number with incontinence not improved, crossover studies (women's observations) Show forest plot

Other data

No numeric data

4.1 Oetrogens versus PPA

Other data

No numeric data

5 Number with incontinence (objective observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 oestrogen vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number with incontinence not improved (objective observations) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 oestrogen vs PPA

1

29

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.46, 1.90]

6.2 oestrogen vs PFMT

2

69

Risk Ratio (M‐H, Fixed, 95% CI)

1.62 [1.18, 2.23]

6.3 oestrogen vs electrostimulation

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.95, 1.75]

7 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 oestrogen vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of voids over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

8.1 oestrogen vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 oestrogen vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Adverse effects Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

10.1 oestrogen vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Maximum urethral closure pressure (MUCP) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11.1 oestrogen vs PFMT

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.2 oestrogen vs electrostimulation

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Maximum urethral closure pressure (MUCP), crossover studies Show forest plot

Other data

No numeric data

12.1 Oetrogens versus PPA

Other data

No numeric data
Figuras y tablas -
Comparison 2. Oestrogen versus other treatments
Ir a la tabla de la revisión
Comparison 3. Oestrogen + other treatments versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence not improved (women's observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 oestrogen + progesterone vs placebo

2

1514

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [1.01, 1.16]

2 Incontinence not improved (generic inverse variance) (women's observations) Show forest plot

3

Relative Risk (Fixed, 95% CI)

Subtotals only

2.1 Systemic administration of oestrogen + progesterone vs placebo

3

10635

Relative Risk (Fixed, 95% CI)

1.11 [1.04, 1.18]

3 Incontinent episodes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of diurnal voids per 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number of nocturnal voids per 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6.1 oestrogen + progesterone vs placebo

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Use of drugs for incontinence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 oestrogen + progesterone vs placebo

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of women having incontinence surgery Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 oestrogen + progesterone vs placebo

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 3. Oestrogen + other treatments versus placebo
Ir a la tabla de la revisión
Comparison 4. Oestrogen + other treatments versus oestrogen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence not improved (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Oestrogen + PPA vs oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number with incontinence not improved (women's observations) (cross‐over trials) Show forest plot

Other data

No numeric data

2.1 oestrogen + PPA vs oestrogen

Other data

No numeric data

3 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 oestrogen + PPA vs oestrogen

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of voids over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 oestrogen + PPA vs oestrogen

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 oestrogen + PPA vs oestrogen

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number of women with frequency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 oestrogen + progesterone vs oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 oestriol + benzidamine vs oestriol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Number of women with nocturia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

7.1 oestriol + benzidamine vs oestriol

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number with adverse effects Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

8.1 Oestrogen + PPA vs oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Volume at first urge to void (cross‐over trials) Show forest plot

Other data

No numeric data

9.1 oestrogen + PPA vs oestrogen

Other data

No numeric data

10 Maximum bladder capacity (cross‐over trials) Show forest plot

Other data

No numeric data

10.1 oestrogen +other vs oestrogen

Other data

No numeric data
Figuras y tablas -
Comparison 4. Oestrogen + other treatments versus oestrogen
Ir a la tabla de la revisión
Comparison 5. Oestrogen + other treatments versus other treatments

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence (women's observations) Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 oestrogen + PFMT vs PFMT

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 TVT vs TVT + vaginal oestrogen

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number with incontinence not improved (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 oestrogen + PPA vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 oestrogen + PPA vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of voids over 24 hours Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 oestrogen + PPA vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 detrusitol + vaginal oestrogen vs detrusitol m

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 oestrogen + PPA vs PPA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Adverse effects Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 oestrogen + PPA vs PPA

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 oestrogen + PFMT vs PFMT

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 5. Oestrogen + other treatments versus other treatments
Ir a la tabla de la revisión
Comparison 6. Different types of oestrogen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number with incontinence not improved (women's observations) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of women with nocturia Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number of women with dysuria Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number of women with urgency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 oestrogen cream vs vaginal oestrogen + progesterone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Number of women with frequency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 oestrogen cream vs vaginal oestrogen + progesterone

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Number of adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 oestradiol ring vs oestriol pessary

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 6. Different types of oestrogen
Ir a la tabla de la revisión
Comparison 7. Different routes of administration

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of pad changes over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 oestrogen cream vs oestrogen orally

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of voids over 24 hours Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 oestrogen cream vs oestrogen orally

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Pad test weights Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 oestrogen cream vs oestrogen orally

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 7. Different routes of administration
Ir a la tabla de la revisión
Comparison 8. High‐dose versus low‐dose oestrogen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of voids over 24 hours Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

‐1.02 [‐1.87, ‐0.16]

2 Number of nocturnal voids Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

‐1.80 [‐2.36, ‐1.24]

3 Maximum urethral closure pressure (MUCP) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

3.84 [‐5.77, 13.46]

4 Volume at first urge to void Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

‐1.56 [‐12.20, 9.08]

5 Maximum bladder capacity Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 high dose vs low dose

2

65

Mean Difference (IV, Fixed, 95% CI)

34.90 [8.35, 61.45]
Figuras y tablas -
Comparison 8. High‐dose versus low‐dose oestrogen
Ir a la tabla de la revisión