Vaginal oestrogen protects against incontinence

APPLICATION of local vaginal oestrogen may improve or even cure incontinence in postmenopausal women, researchers say, though its benefits may not continue after treatment ceases.

A review of 33 trials found local oestrogen therapy improved incontinence by 26% compared to placebo.

Overall, there were one or two fewer voids in 24 hours and fewer nocturnal voids among women treated with local oestrogen, and urgency was also reduced.

Some users experienced vaginal spotting, breast tenderness or nausea, but no serious adverse events were reported among users of local oestrogen.

However, the authors said there was little evidence on whether these improvements continued after treatment ceased.

They said the risk of endometrial and breast cancer after long-term use suggested that any oestrogen treatment should be used for limited periods.

The authors found that in two large trials where women received hormone replacement therapy, including oral oestrogen, incontinence was worsened by 32% when compared to placebo. This effect was lessened when adjusted to include only women with an intact uterus.

“The risks of long-term treatment with oestrogens suggest that treatment should be for limited periods, and using local (vaginal) rather than systemic administration, if possible, especially in women with an intact uterus,” the authors said.

Other Cochrane highlights

• NON-TRAMADOL opioids should not be routinely used for treating osteoarthritis of the knee or hip, even if pain is severe, reviewers have concluded.

A meta-analysis of 10 randomised or quasi-randomised controlled trials, including 2268 participants, found that while opioids were more effective than control interventions overall, they were also associated with a 55% increased risk of adverse events. Trial dropout was four times higher for patients receiving opioids.

There were no substantial differences in effects according to the type of opioid used, analgesic potency, dosage or duration of treatment.

“The small to moderate beneficial effects of non-tramadol opioids are outweighed by the large increase in the risk of adverse events,” the authors said.

• TOPICAL capsaicin may provide some pain relief for patients experiencing various types of neuropathic pain conditions, but it may also increase local skin irritation such as burning and stinging.

The authors of a review of six small studies found capsaicin, alone or in combination with other treatments, might provide useful pain relief in patients who cannot tolerate or who fail to respond to other treatments.

However, they said the strength of their findings was limited by the small number of participants in the six trials, which included placebo controlled trials.

Cochrane Database Syst Rev 2009, Issue 4