Effects of vaginal DHEA on stress urinary incontinence in postmenopausal women with vulvovaginal atrophy

Objectives: To evaluate the effects of vaginal dehydroepiandrosterone (DHEA) on stress urinary incontinence (SUI) and pelvic floor muscle (PFM) function in postmenopausal women (PMW) suffering from vulvovaginal atrophy (VVA). Study design: This prospective observational pilot study included 34 PMW with VVA and moderate SUI. Eligibility criteria included no hormonal therapy nor infections. Participants received 6.5 mg/day vaginal DHEA for 12 weeks, and SUI symptoms and PFM function were assessed before and after treatment. Main outcome measures: Primary outcome was SUI improvement, which was measured using a 3-day bladder diary and the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). Secondary outcomes included the assessment of PFM function, which was evaluated using the Modified Oxford Scale (MOS). Results: After 12 weeks of treatment, there was a statistically significant reduction in SUI episodes (p < 0.001). The median ICIQ-UI SF score decreased from 12 to 9 (p < 0.001), indicating a significant reduction in urinary symptoms. Additionally, there was a significant improvement in PFM tone, as reflected in higher MOS scores (p < 0.001). Conclusion: Vaginal DHEA treatment has been shown to significantly alleviate urinary symptoms, enhance quality of life, and strengthen PFM function in PMW with SUI and VVA. Further studies are required to confirm these findings and to explore the potential of androgen therapy in the treatment of SUI.