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Is Add-on Therapy with Vaginal Estrogen Better than Anti-Muscarinergic Therapy Alone in Treatment of Urgency Urinary Incontinence in Postmenopausal Women? - A Systematic Review and Meta-Analyses

Jimmi Elers and Julie B Hansen

The purpose of this systematic review was to examine weather addon therapy with vaginal estrogen exerts any benefits or side effects on urgency urinary incontinence in postmenopausal women. As part of a national guideline we aimed to systematically assess the existing literature on vaginal estrogen used in combination with Anti-muscarinic medicine in postmenopausal women with urgency urinary incontinence. A systematic literature search was done in Medline, the Cochrane Library, EMBASE, CINAHL and PEDro from inception to June 2015. The primary search included guidelines and systematic reviews comparing vaginal estrogens as add-on to any Anti-muscarinic medicine compared to Anti-muscarinic medicine alone. The population was postmenopausal women with symptomatic overactive bladder syndrome with or without urgency urinary incontinence. In total 49 systematic reviews was identified and one was included. An updated literature search identified further 17 randomized controlled trials, but none was included. All studies were double-screened. In total 2 randomized controlled trials was eligible. The evidence was of poor methodological quality. The study population was women with overactive bladder syndrome with or without urgency urinary incontinence. The pharmaceutical properties of the used vaginal estrogen differed from studies regarding specific estrogen type, dosage form and doses. There were no effects of add-on therapy with vaginal estrogen to Anti-muscarinic medicine regarding patient reported effect, urinary incontinence related quality of life, number of daily voidings, number of incontinence episodes daily. Furthermore the studies lacked reports on patient dropouts and harmful effects.