The use of hormones to treat stress urinary incontinence (SUI) has fallen out of favor because of concerns over safety following publication of the Women's Health Initiative study. In addition, there are data that suggest that estrogen treatment does not help SUI. As women age, the decline in androgen output mirrors the increasing prevalence of SUI implying a potential causal association. Therefore, we suggest that androgens are the 'forgotten female hormone.' Vaginal estrogens can treat pelvic floor structures without significant systemic effects; we suggest that vaginal androgens can act similarly and thereby avoid the unwanted systemic effects of androgenization in women. Based on available preclinical and clinical data, we suggest that research should investigate vaginal treatment with androgen hormones as adjunctive therapy to pelvic floor exercises for SUI. In a postmenopausal woman, this could be supplemented with estrogens if trial data warrant it.
International urogynecology journal. 2022 Apr 23 [Epub ahead of print]
Nicholas Siddle, Eboo Versi, Rutgers Robert
Gholdenphish Ltd, London, UK., Department of Obstetrics, Gynecology and Reproductive Sciences, Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA. ., Department of Obstetrics, Gynecology and Reproductive Sciences, Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.