Menopausal Hormone Therapy Curbs Nocturia by Improving Sleep

By Megan Brooks

March 19, 2021

NEW YORK (Reuters Health) - A small pilot study shows that women taking hormone therapy to ease hot flashes and other menopausal symptoms also make fewer trips to the bathroom overnight.

"Systemic hormone therapy led to a significant reduction in nocturia prevalence and improvement in bother and this effect can mainly be explained by an improvement in sleep quality," lead investigator Dr. Kim Pauwaert of Ghent University Hospital, in Belgium, said in a video presentation of the results, which appear in the journal Menopause.

Her study involved 245 postmenopausal women (median age, 53) receiving different systemic hormonal therapies based on their own choice: estrogen plus progesterone (133 women), estrogen only in women with prior hysterectomy (47 women), tissue-selective estrogen complex (33 women) or no treatment (32 women).

Overall, there was a significant reduction in the prevalence of nocturia after six months of hormone therapy, as the ratio of women reporting nocturia (defined as waking up two or more times nightly to go to the bathroom) fell from 28% at pre-treatment baseline to 16% at six months.

In addition, a significantly higher percentage of women reported either one or no nocturnal voids after treatment (one void: 45% before vs. 51% after treatment; no nocturnal voids: 27% before vs. 32% after treatment; both P<0.001).

When looking at the effect of the individual hormone therapies, a significant reduction in nocturnal voiding frequency was observed in women treated with estrogen plus progesterone and those treated with tissue-selective estrogen complex. This improvement was explained by a significant improvement in sleep.

"To our knowledge, this study is the first to assess the relation between different menopausal hormonal therapy options and nocturia," the researchers write.

"The findings of this study are important, as both the reduction of nocturia and the associated bother have implications on women's health and quality of life. This study supports a hypothesis to test in a future randomized study, namely that different systemic and vaginal estrogens will be more effective at reducing nocturia frequency than maintaining hormone depletion," they add.

In a phone interview with Reuters Health, Dr. Stephanie Faubion, medical director for The North American Menopause Society (NAMS), noted that "getting up at night to go to the bathroom is a pretty common problem and it happens more often after menopause. There are probably a number of reasons for that, including losing estrogen and the changes in the genital urinary tract."

"This study shows that estrogen therapies, both the estrogen plus progesterone and the tissue-selective complex, can help with this but it may not be a direct effect. Rather, it may be an effect on improving sleep in general, which makes women sleep through the night better," said Dr. Faubion, who wasn't involved in the study.

"So while I think it can be used as an indirect therapy, hormone therapy is not used for nocturia, specifically. That's not an indication for the use of hormone therapy. But if a woman is having lots of hot flashes and night sweats and sleep disturbances, she probably is going to sleep through the night better and be able to ignore the small bladder urges that they get if she's on hormone therapy," Dr. Faubion added.

The study had no commercial funding.

SOURCE: Menopause, online March 17, 2021.