The pelvic floor contains receptors for oestrogen and progesterone. HRT therefore affect its function. A study in 2019 considered the use of estradiol-progestogen postmenopausal hormone therapy in women with a uterus with a uterine prolapse surgery. They found that HRT is accompanied by elevated risk for uterine prolapse.

The women with uterine prolapse had used hormone therapy more often.  The use of hormone therapy was accompanied by significant (23%-53%) increase in the risk of prolapse, being higher with longer exposure. The risk elevations(33%-23%) were comparable between sole norethisteroneacetate-estradiol and sole medroxyprogesteroneacetate-estradiol therapy.

The use of estradiol in combination with a levonorgestrel releasing intrauterine device (Mirena coil) was accompanied by a 52% elevation.

Stress Incontinence

The use of systemic estradiol-only or estradiol-progestin therapy was accompanied by an increased SUI risk. The use of estradiol with noretisterone acetate showed a higher risk of increase than that with medroxyprogesterone acetate.

Women aged over 55 years at the start of systemic HT was accompanied by a higher SUI risk increase than that under 55 years of age. The use of tibolone, an estradiol + levonorgestrel-releasing intrauterine device, or vaginal estradiol also increased the risk.

Warning

The use of HT regimens may predispose to the de novo development or worsening of pre-existing SUI  as well as uterine prolapse. Thus, caution is needed when these regimens are prescribed to women with mild stress-related urine leakage or with established SUI risk factors. This data should be incorporated into the information given to the users of estradiol-progestogen hormone therapy. This is of particular importance if a coil is recommended.

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