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BMJ 2005; 330 doi: (Published 03 March 2005) Cite this as: BMJ 2005;330:501
  1. Alison Tonks, associate editor (

    HRT worsens incontinence in postmenopausal women

    Until recently, hormone replacement therapy (HRT) was thought to be good for incontinence. The latest analyses from the women's health initiative trials show that it isn't. In these two placebo controlled trials, HRT with or without progestogen increased the risk of incontinence in women who were originally continent and made symptoms worse for women who already had problems. The risks were highest for stress incontinence: hormone replacement doubled the risk of new symptoms compared with placebo (relative risk 1.87 with combined HRT and 2.15 with oestrogen alone). Any kind of hormone therapy made existing symptoms more frequent, more bothersome, and more likely to limit women's activities compared with placebo.

    The two women's health initiative trials were set up originally to test the impact of oestrogen with or without progestogen on heart disease and osteoporosis in healthy postmenopausal women. More than 23 000 women were included in the analysis of incontinence after one year of treatment. Women in the active treatment groups took oestrogen plus medroxyprogesterone or oestrogen alone.

    Does this spell the end for hormone replacement therapy in the management of incontinence? The authors don't say so, but a linked editorial warns doctors to stop prescribing long term oestrogens as a treatment for any kind of incontinence in postmenopausal women.

    Ciprofloxacin is better than co-amoxiclav for cystitis

    Cystitis is common and usually easy to treat. But bacterial resistance to the traditional co-trimoxazole has increased the prescribing of alternatives such asco-amoxiclav and ciprofloxacin. In the first head to head trial, ciprofloxacin was significantly more effective than co-amoxiclav, curing more women of their symptoms, their infection, and their vaginal reservoir of bacteria. A total of 322 women with symptoms of cystitis and a positive urine culture (mostly Escherichia coli) took co-amoxiclav (500 mg amoxicillin, 125 mg clavulanate) or ciprofloxacin (250 mg) twice daily for three days and were followed …

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