Hormone therapy for postmenopausal women with nocturia

The Belgium pilot study in the journal Menopause concluded that results were especially positive for both estrogen + progesterone (E+P) and tissue-selective estrogen complex (TSEC).

“Our research group focuses on nocturia,” said co-author Kim Pauwaert, MD, a urology resident at Ghent University Hospital in Belgium. “Moreover, in clinical practice, we find that a lot of postmenopausal women suffer from nocturia.”

Previously, Pauwaert and her team conducted an exploratory study to observe the impact of nocturia among Belgian postmenopausal women.

The current study sought to observe if hormonal treatment is effective in the same population.

All 245 postmenopausal women were recruited from the gyn department of Ghent University Hospital between March 2018 and January 2020.

The women were divided into 4 groups, based on patient choice: E+P (n = 133); estrogen-only in patients with a prior hysterectomy (n = 47); TSEC (n = 33); and no treatment (n = 32).

Nocturia and its causative factors were observed using two standardized questionnaires before and after treatment: the International Consultation on Incontinence Questionnaire Nocturia Module (ICIQ-N) and the Targeting the individual’s Aetiology of Nocturia to Guide Outcomes (TANGO).

For the 3 treatment groups overall, there was a significant reduction in prevalence of nocturia twice per night: from 27.7% to 16.4%.

The most pronounced reduction was noted in patients treated with either E+P or TSEC: P = 0.018 for both groups.

However, a significantly higher percentage of women reported either 1 nocturnal void or no nocturnal voids after 1 of the 3 treatments. This improvement from baseline was 45.1% to 51.2% for one void (P < 0.001) and 27.2% to 32.4% for two voids (P < 0.001).

At baseline, 45% of women who opted for hormonal therapy reported 1 nocturnal void. But for 67.7% of these women, 6 months of treatment did not change nocturnal frequency, and in 8.3% there was an increase of nocturnal frequency to 2 voids per night.

On the other hand, 24% of women with 1 nocturnal void at baseline experienced a decline to no nocturnal voids after treatment (P < 0.001).

These improvements could be attributed to a significant reduction in the sleep sum score in patients treated with E+P or TSEC: P < 0.001 and P = 0.013, respectively.

Although not specifically investigated, these encouraging sleep results may reflect a change in hot flashes because perspiration and sweating during the night disturbs sleep.

Estrogen-only therapy led to a significant reduction in the urinary tract sum score, which was the result of a decrease in urgency prevalence (P = 0.039).

“We expected to achieve these results,” Pauwaert told Contemporary OB/GYN. “However, we hoped to see an effect on renal and bladder functions, but this was not observed well during the study period.”

In Pauwaert’s opinion, postmenopausal women suffering from nocturia due to underlying sleep problems could benefit from hormonal treatment in order to decrease nocturnal frequency.

The study supports testing in a future randomized study whether the different systemic and vaginal estrogens are more effective at reducing nocturia frequency than maintaining hormone depletion, according to Pauwaert.

Meanwhile, she and her colleagues have planned a follow-up study to assess the effect of hormone therapy on kidney and bladder function.

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Disclosure

Pauwaert received a research grant from Ferring Pharmaceuticals.

Reference

Pauwaert K, Goessaert AS, Ghijselings L, et al. Hormone therapy as a possible solution for postmenopausal women with nocturia: results of a pilot trial. Menopause. Published online March 15, 2021.

doi:10.1097/GME.0000000000001741