Hormone Replacement for Pelvic Floor Disorders

Purpose of Review The purpose of this review article is to summarize the recent literature regarding the effect of hormone replacement therapy on pelvic floor disorders and its role as a preventative or treatment option. Recent Findings The recent evidence describing the effect of hormone replacement therapy on pelvic floor disorders is mainly limited to cohort studies, systematic reviews, and secondary analysis of randomized controlled trials such as the Women's Health Initiative and Nurses' Health Study. There are few quality randomized controlled trials, especially within the last 5 years on this topic. The data that does exist does not show hormone therapy to be beneficial in the treatment or prevention of pelvic floor disorders. In fact, it may worsen urinary and fecal incontinence when given systemically. The exception to this is the local application of vagina estrogen, where it may be of some benefit in the treatment of urinary incontinence. Local application has been shown to be beneficial when treating genitourinary syndrome of menopause and in the prevention of recurrent urinary tract infections. There is a paucity of quality data regarding the secondary effects and use of hormone replacement as a treatment for pelvic floor disorders. Given the lack of studies, limited efficacy, and possible side effects, it should not be offered as first-line or single treatment for pelvic floor disorders such as urinary or fecal incontinence and pelvic organ prolapse. It may be used as a treatment for genitourinary syndrome of menopause and for prevention of urinary tract infections when placed locally in the vagina.