Anticholinergics and β3 agonists are the mainstay of medical treatment for overactive bladder symptoms (OAB). Vaginal oestrogen has been shown to improve OAB symptoms. This review evaluated combination therapy (vaginal oestrogen + OAB medication) versus monotherapy.
The project was registered with PROSPERO (CRD42023462373). A literature search of Embase, MEDLINE and CINAHL was conducted. Articles were screened independently by two reviewers according to PRISMA guidelines. Statistical analyses were performed using Review Manager (RevMan v5.4.1, Cochrane Collaboration). Study quality was assessed using the Newcastle-Ottawa scale.
Initial search yielded 17 results. After screening, six articles were included in qualitative synthesis and four in quantitative synthesis. Five studies were randomised controlled trials, and one was non-randomised. All articles were of good quality (≥ 7 points Newcastle-Ottawa scale). Total number of participants was 544. Four studies reported that combination therapy is associated with significantly greater improvements in OAB symptoms, health-related quality of life (HRQL) and/or sexual function. Two studies reported no significant difference in OAB symptoms between monotherapy and combination therapy. Pooled analysis showed a significant reduction in urinary frequency with combination therapy compared with monotherapy (SMD -0.36 [-0.63, -0.08], p = 0.01, I2 = 0%). However, no significant difference was observed in OAB symptoms score (SMD -0.38 [-0.81, 0.05], p = 0.08, I2 = 60%) or health-related quality of life (SMD -0.15 [-0.41, 0.10], p = 0.24, I2 = 0%).
Combination therapy may benefit urinary frequency but did not demonstrate significant improvement in overall OAB symptoms or HRQL. Further research is required to determine the benefit of vaginal oestrogen.
International urogynecology journal. 2026 Apr 13 [Epub ahead of print]
Sharifah Naseem, Victoria Kershaw, Aethele Khunda, Sami Shawer, Paul Ballard
Department of Urogynaecology, South Tees University Hospital NHS Foundation Trust, Middlesbrough, UK. ., Department of Urogynaecology, South Tees University Hospital NHS Foundation Trust, Middlesbrough, UK.