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Cochrane Database of Systematic Reviews

Oestrogen therapy for urinary incontinence in post-menopausal women

Overview of attention for article published in Cochrane database of systematic reviews, October 2012
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (97th percentile)
  • High Attention Score compared to outputs of the same age and source (85th percentile)


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Oestrogen therapy for urinary incontinence in post-menopausal women
Published in
Cochrane database of systematic reviews, October 2012
DOI 10.1002/14651858.cd001405.pub3
Pubmed ID

June D Cody, Madeleine Louisa Jacobs, Karen Richardson, Birgit Moehrer, Andrew Hextall


It is possible that oestrogen deficiency may be an aetiological factor in the development of urinary incontinence in women. This is an update of a Cochrane review first published in 2003 and subsequently updated in 2009. To assess the effects of local and systemic oestrogens used for the treatment of urinary incontinence. We searched the Cochrane Incontinence Group Specialised Register of trials (searched 21 June 2012) which includes searches of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and handsearching of journals and conference proceedings, and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials that included oestrogens in at least one arm in women with symptomatic or urodynamic diagnoses of stress, urgency or mixed urinary incontinence or other urinary symptoms post-menopause. Trials were evaluated for risk of bias and appropriateness for inclusion by the review authors. Data were extracted by at least two authors and cross checked. Subgroup analyses were performed by grouping participants under local or systemic administration. Where appropriate, meta-analysis was undertaken. Thirty-four trials were identified which included approximately 19,676 incontinent women of whom 9599 received oestrogen therapy (1464 involved in trials of local vaginal oestrogen administration). Sample sizes of the studies ranged from 16 to 16,117 women. The trials used varying combinations of type of oestrogen, dose, duration of treatment and length of follow up. Outcome data were not reported consistently and were available for only a minority of outcomes.The combined result of six trials of systemic administration (of oral systemic oestrogens) resulted in worse incontinence than on placebo (risk ratio (RR) 1.32, 95% CI 1.17 to 1.48). This result was heavily weighted by a subgroup of women from the Hendrix trial, which had large numbers of participants and a longer follow up of one year. All of the women had had a hysterectomy and the treatment used was conjugated equine oestrogen. The result for women with an intact uterus where oestrogen and progestogen were combined also showed a statistically significant worsening of incontinence (RR 1.11, 95% CI 1.04 to 1.18).There was some evidence that oestrogens used locally (for example vaginal creams or pessaries) may improve incontinence (RR 0.74, 95% CI 0.64 to 0.86). Overall, there were around one to two fewer voids in 24 hours amongst women treated with local oestrogen, and there was less frequency and urgency. No serious adverse events were reported although some women experienced vaginal spotting, breast tenderness or nausea.Women who were continent and received systemic oestrogen replacement, with or without progestogens, for reasons other than urinary incontinence were more likely to report the development of new urinary incontinence in one large study.One small trial showed that women were more likely to have an improvement in incontinence after pelvic floor muscle training (PFMT) than with local oestrogen therapy (RR 2.30, 95% CI 1.50 to 3.52).The data were too few to address questions about oestrogens compared with or in combination with other treatments, different types of oestrogen or different modes of delivery. Urinary incontinence may be improved with the use of local oestrogen treatment. However, there was little evidence from the trials on the period after oestrogen treatment had finished and no information about the long-term effects of this therapy was given. Conversely, systemic hormone replacement therapy using conjugated equine oestrogen may worsen incontinence. There were too few data to reliably address other aspects of oestrogen therapy, such as oestrogen type and dose, and no direct evidence comparing routes of administration. The risk of endometrial and breast cancer after long-term use of systemic oestrogen suggests that treatment should be for limited periods, especially in those women with an intact uterus.

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X Demographics

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 302 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 <1%
Colombia 1 <1%
Poland 1 <1%
France 1 <1%
Unknown 298 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 40 13%
Student > Bachelor 32 11%
Researcher 31 10%
Student > Ph. D. Student 27 9%
Other 26 9%
Other 53 18%
Unknown 93 31%
Readers by discipline Count As %
Medicine and Dentistry 117 39%
Nursing and Health Professions 33 11%
Psychology 11 4%
Social Sciences 8 3%
Sports and Recreations 7 2%
Other 31 10%
Unknown 95 31%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 42. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 February 2022.
All research outputs
of 23,106,934 outputs
Outputs from Cochrane database of systematic reviews
of 12,367 outputs
Outputs of similar age
of 176,480 outputs
Outputs of similar age from Cochrane database of systematic reviews
of 234 outputs
Altmetric has tracked 23,106,934 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 12,367 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 32.3. This one has done well, scoring higher than 85% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 176,480 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 97% of its contemporaries.
We're also able to compare this research output to 234 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 85% of its contemporaries.