Funcionalidade de mulheres com incontinência urinária na pré e pós menopausa

Abstract

Climacteric is the period of a woman's life characterized by metabolic and hormonal changes, marked by menopause, and can be divided into different menopausal stages: pre, peri, and post-menopause. The hormonal decrease associated with muscle changes contributes to urinary incontinence (UI). These changes can affect physical, social, psychological, occupational, and sexual problems, affecting these women's functioning. The adequate assessment of functioning at this stage aims to identify the repercussions in different domains of life and enables the targeting of preventive strategies. Current studies address adverse health outcomes in postmenopausal women, such as strength deficit. However, the association of the menopausal stage with functioning in women with UI in the climacteric phase is unknown. Therefore, the present study aims to evaluate functioning in this population, considering its domains of life, and to analyze the association between the menopausal stage and functioning in women with UI in the climacteric phase. This work is a cross-sectional study carried out with women with UI from 40 years old, attended at the Maternity School Assis Chateaubriand (MEAC), in Fortaleza city, between March 2020 and April 2022. Data collection was carried out through a questionnaire with sociodemographic data, anthropometric measurements, urogynecological and obstetrical history, and the classification of the menopausal stage (STRAW). Subsequently, the women answered the following instruments: World Health Disability Assessment Schedule 2.0 (WHODAS 2.0), Menopause Rating Scale (MRS), Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and, finally, performed the sit-stand and grip strength tests. The Mann-Whitney test, the Spearman correlation, and multiple linear regression were used for the statistical analysis, considering a significance level of 5%. A total of 113 women with an average age of 54.5 (9.7) years were evaluated, 44 (38.9%) were premenopausal, and 69 (61.1%) were postmenopausal. A mean of 18.6 points was observed in the MRS, 15.09 in the WHODAS, and 55% of the women had mixed UI. In the multiple linear regression model, after adjusting for covariates, we observed no association between the menopausal stage and functioning (p > 0.05). However, we observed that the covariates climacteric symptoms (MRS) (p = 0.04) and impact of UI symptoms on activities and participation (PFIQ-7) (p < 0.001) are associated with functioning (WHODAS total). Although published studies show more negative outcomes related to hormone reduction and a higher prevalence of UI in postmenopausal women, when considering the WHODAS, which assesses functioning and disability, we did not observe an association with the menopausal stage. The postmenopausal group had the worst absolute values in the cognition, self-care, and interpersonal relationships domains. In contrast, the premenopausal group had worse scores in mobility, life activities, and participation. With this, we understand that during the climacteric period, there may be a need to observe the impacts in different domains of life. There was no association between the menopausal stage and level of functioning and disability in women with urinary incontinence. Other factors such as climacteric symptoms and the impact of UI symptoms can interfere with functioning. The results presented here allow for the elaboration of prevention and treatment strategies in the health care of women with UI during the climacteric period, based on a better understanding of functioning in this population.