Correlates of urinary incontinence during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women's Health Study.

BACKGROUND

Urinary incontinence (UI) becomes more prevalent as women age, but little is known about UI in midlife, including stress incontinence (SUI) and urge incontinence (UUI) and their relationship to reproductive aging, reproductive history, health-related factors, and personal and social factors associated with midlife.

OBJECTIVES

To determine the influence of age and reproductive aging factors (menopausal transition stages, follicle stimulating hormone (FSH), estrone glucoronide), reproductive history (number of live births), health-related factors (perceived health, body mass index (BMI), exercise, diabetes) and personal and social factors (race/ethnicity, education) on the experience of UI among midlife women during the menopausal transition and early postmenopause.

METHODS

A subset of the Seattle Midlife Women's Health Study participants (n = 298 with up to 2249 observations) provided data during the late reproductive, early and late menopausal transition stages and early postmenopause, including menstrual calendars, annual health questionnaire and provided health diaries since 1990. Generalized estimating equation analysis was used to test models accounting for SUI and UUI that included age as a measure of time with predictors.

RESULTS

Stress urinary incontinence was associated significantly with individual predictors of: worse perceived health (odds ratio (OR) 0.89, p = 0.025), history of ≥ three live births (OR 3.00, p = 0.002), being in the early menopausal transition stage (OR 1.53, p = 0.06), having less formal education (OR 0.33, p = 0.02), and being White/not Black (OR 0.32, p = 0.04). The most parsimonious model for SUI included: worse perceived health, ≥ three live births, and being White. Urge incontinence was associated significantly with individual predictors of: increasing age (OR 1.06, p = 0.001), worse perceived health (OR 0.78, p < 0.001), BMI ≥ 30 kg/m(2) (OR 2.96, p = 0.001), history of ≥ three live births (OR 2.81, p = 0.01), and lower FSH levels (OR 0.59, p = 0.08). The most parsimonious model for UUI included: being older, having worse perceived health, and having a high BMI.

CONCLUSIONS

SUI risk was a function of reproductive history, poor health, and being White. UUI risk was a function of aging, having worse health, and higher BMI. Further exploration of UI during the menopausal transition is needed to articulate a lifespan view of UI and its typology.