Estrogen replacement propitiates significantly incontinence improvement and of most of the mentioned symptoms, even though the action mechanism is not completely known.
In our casuistic, in the Urogynecological and Vaginal Surgery of the Department of Gynecology of UNIFESP-EPM Sector, the estroprogestogen therapeutic in women with stress urinary incontinence without uterine prolapse and with first or second degree cystocele, propitiates a significant clinical improvement, with diminishing of the urinary loss episodes and residual urine, as well as a significant raise of bladder capacity, of urethral closure pressure and the medium urinary flow(24).
We have evaluated hormonal replacement effects upon the responsible elements of urinary continence. In this manner we analized the different therapeutic schemes, through experimental studies and clinical tests, with different drugs and ways of administration. We observed that the symptoms and effects resulting from estrogenic deficiency are reverted with relative ease. It is obvious that the answer is quickest when the potency of the drug is larger. We prefer systemic hormone therapy for several reasons, from which we stress that the using of topic preparations for long periods of time, end up by bothering the patients, and to depend on the product, it may produce a prolongued and continuous estrogenic stimulus, increasing the risk of endometrium carcinoma, without the patient or the doctor knowing it; topic vaginal therapy does not produce the beneficial effects in other organs and tissues.
We must emphasize the criterion for estrogenic replacement, as well as the need of a rigorous accompaniment so an unforeseen event does nor occur.
To end this, we must point out that we adopted as a routine to begin the therapeutic of patients with stress urinary incontinence, with hormonal replacement, when the symptoms began or became pronounced with the advent of menopause. At the moment we give preference to the continuous estroprogestogen scheme with conjugated equine estrogen associated to medroxyprogesterone acetate.