Friday Q&A: urinary infections & incontinence; estrogen use in breast cancer patients; testosterone for women; & pelvic floor dysfunction
You ask the best questions!
It’s Friday Q&A time!
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
The first question today (about urinary incontinence) is for all subscribers. The remaining questions (about estrogen in breast cancer patients; testosterone for women; pelvic floor weakness; & frequent UTIs) are for paid subscribers.
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Let’s dive in!
QUESTION #1
I get urinary tract infections and urinary incontinence and have been told the only thing I can do is self-catheterize! I’ve tried Detrol and Myrbetriq but no luck. Would vaginal estrogen help?? I am miserable.
-Beth
Dear Beth,
Medications like Detrol and Myrbetriq are certainly an option for patients with incontinence, but they can have unpleasant side effects and don’t always work. If you were my patient, I would first assess your hormonal status and offer you vaginal estrogen if appropriate. Vaginal estrogen has been shown to improve symptoms of genitourinary syndrome of menopause (GSM) which include vaginal dryness, urinary incontinence, and the increased risk of urinary infections as a result of thin, atrophic vaginal tissue. Vaginal estrogen is typically safe for women within 10 years of their last menstrual period—and even after 10 years, depending on the patient.
Next, I would suggest cutting back on foods and drinks that tend to irritate the bladder—like spicy food, caffeine, and alcohol—and limiting your intake of liquids 3 hours before bedtime.
I would then refer you to a uro-gynecologist (a specialist in female reproductive organs and pelvic anatomy) for a thorough assessment of your pelvic floor anatomy and function. If it we learned that you have weak pelvic muscles, you might benefit from pelvic floor physical therapy to strengthen your deep core.
The upshot? I do have some patients for whom self-catheterization is the only option for their urinary issues, but this recommendation is usually made only after we’ve addressed all mechanical, hormonal, and behavioral factors first.
I hope that helps!
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QUESTION #2
I’m on long-term treatment for metastatic estrogen+ breast cancer. I’ve always thought vaginal estrogen therapy was contraindicated. But I have significant vaginal atrophy and get frequent symptoms of UTI (not always positive for UTI). What is the best thinking on this issue?
-Judith
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