Introduction

This information is for people who have stress incontinence. It tells you about hormone replacement therapy (HRT), a treatment used for stress incontinence. It is based on the best and most up-to-date research.

Does it work?

There's some evidence that using oestrogen cream or tablets in the vagina helps improve stress incontinence. But other forms of HRT (such as tablets you swallow, for example) may make the problem worse.

There are risks with taking HRT that may increase the longer you take it. HRT may increase your risk of breast cancer, heart disease, a stroke, or blood clots in your lungs (pulmonary embolism), although doctors think the risks are lower with vaginal HRT. Doctors usually only advise you take HRT for incontinence for a limited time.

What is it?

HRT stands for hormone replacement therapy. You can get several forms of HRT, including creams and tablets that you put in your vagina.

Most forms of HRT contain a type of oestrogen. Oestrogen is the main female hormone. Oestrogen is important for a healthy reproductive system (the parts of your body that let you get pregnant and give birth). Oestrogen may also be important for keeping other parts of your body in good condition. They include your bladder, urethra (the tube which takes urine out), vagina, and the muscles of the pelvic floor.

Many women take HRT around the menopause to replace some of the oestrogen that the body stops making at this time. Doctors normally prescribe it to relieve symptoms such as hot flushes or a dry vagina. But your doctor might suggest you try a short course of HRT if you're deciding whether to have surgery for stress incontinence, or if you have to wait a long time for an operation.

If you still have your womb, you'll be offered a combination of oestrogen and another hormone called progestogen. Taking oestrogen on its own increases your risk of getting cancer of the lining of the womb (endometrial cancer). Adding progestogen to the oestrogen lowers your risk of getting this kind of cancer. This type of treatment is known as combined HRT. Some common brands of combined HRT are:

• Evorel

• Nuvelle

• Premique

• Prempak-C.

If you've had an operation to remove your womb (a hysterectomy) you can take oestrogen without progestogen since there is no risk of getting endometrial cancer. Some common brand names of oestrogen-only HRT are:

• Estraderm

• Evorel.

There are lots of HRT products. You can take it as a skin patch, a tablet, or a vaginal ring. To read more, see Different kinds of HRT products.

You can also get oestrogen tablets and creams that you put in your vagina. Some doctors advise taking HRT this way for incontinence. Here are the names of some oestrogen creams and vaginal tablets:

• Estring (vaginal ring)

• Ovestin (cream)

• Vagifem (vaginal tablets).

If you use vaginal cream or tablets, you may still need to take progestogen tablets to protect you against cancer of the lining of the womb.