Zhongguo quanke yixue (Aug 2024)
Effects of Menopausal Hormone Therapy Combined with Pelvic Floor Muscle Training on Pelvic Floor Structure in Patients with Stress Urinary Incontinence
Abstract
Background The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasing, leading to a significant impact on both physical and mental well-being due to stress urinary incontinence (SUI) . Objective To investigate the impact of menopausal hormone therapy (MHT) in conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate SUI. Methods A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital, Capital Medical University in 2022 were selected. They were allocated into the MHT group and the control group in a 2∶1 ratio using a random number table method, and the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen combined with progestogen therapy (EPT) in a 1∶1 ratio. Both the control group and the MHT group underwent pelvic floor muscle training (PFMT), commonly referred to as Kegel exercises, for 15-30 minutes per session, 2-3 times daily, and 2-3 d per weekly, over a continuous period of 12 months. The control group received Kuntai capsules orally in combination with PFMT, with 4 capsules taken per dose, 3 times a day, for 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy (1 mg estradiol valerate + 10 mg dydrogesterone, once daily), continuous sequential estrogen-progestin therapy (femoston 12 courses), and the Tibolone subgroup takes tibolone orally, all of which were administered continuously for 12 months. The study examined serum estradiol (E2) and follicle-stimulating hormone (FSH) levels within and between groups and subgroups before and after treatment. In addition, measurements were obtained for urethral rotation angle (URA), bladder detrusor thickness (BDT), posterior vesicourethral angle (PVUA), levator hiatus area (LHA), urinary incontinence quantification, ICI-Q-SF score, clinical efficacy, as well as changes in the modified Kupperman Menopausal Index (KMI) score, and the modified oxford staging (MOS) . Results Upon completion of the study, 7 participants from the MHT group were lost to follow-up (5 in the Tibolone subgroup and 2 in the EPT subgroup), with 3 participants from the control group also lost to follow-up. In the end, a total of 65 participants were included. After 1 year of treatment, there were no statistically significant differences in FSH, E2, and MOS between the MHT group and the control group (P>0.05). After 1 year of treatment, there were no statistically significant differences in PUVA, BDT, and URA between the MHT group and the control group (P>0.05). However, the LHA of the MHT group was significantly lower than that of the control group (P=0.028). After 1 year of treatment, there were no statistically significant differences in PUVA, BDT, URA, and LHA between the EPT and Tibolone subgroups (P>0.05). Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT group (P=0.005). Conversely, no statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroups (P=0.727). After 1 year of treatment, the MHT group showed lower urinary incontinence quantity, ICI-Q-SF score, and KMI score compared to the control group (P<0.05). Before and after the treatment, there were no statistically significant differences in urinary incontinence quantity, ICI-Q-SF score, and KMI score between the EPT and Tibolone subgroups (P>0.05) . Conclusion The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Nevertheless, there is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.
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