Abstract
OBJECTIVE: To investigate the association between hormonal contraception (HC) and lower urinary tract symptoms (LUTS) and recurrent urinary tract infections (rUTIs) among premenopausal women in the Boston Area Community Health Survey. METHODS: At baseline in 2002-2005 and 5 years later, participants provided information on contraception use, 14 LUTS, and rUTIs. We used this information to investigate HC use (ever, past, current, and ever systemic) in relation to the prevalence and risk of urinary incontinence, other storage symptoms, voiding/emptying symptoms, lower urinary tract pain, and rUTIs. Associations were estimated using Poisson regression with robust variance estimation, adjusting for age, race/ethnicity, vaginal parity, body mass index, waist circumference, cigarette smoking, diabetes, and sexual activity (rUTI analyses only). RESULTS: In both prevalent (n = 881) and incident analyses (n = 608-867, depending on the LUTS), no associations were observed for HC use with urinary incontinence, other storage LUTS, voiding/emptying LUTS, or lower urinary tract pain. In contrast, positive associations were observed for rUTIs in prevalent analyses (ever [adjusted prevalence ratio (aPR) 6.4, 95% confidence interval (CI) 1.0-41.3] and current use [aPR 16.3, 95% CI 1.8-152.1] compared to never use), with similar suggestive positive associations in incident analyses (ever use [adjusted relative risk = 4.4, 95% CI 0.9-21.2] and current use [aPR 5.9, 95% CI 0.7-53.5]). CONCLUSIONS: Our prospective findings do not support associations between HC use and risk of most LUTS or conditions, except for rUTIs. Future studies should explore this association further to determine whether it is explained by residual confounding by sexual activity or the possible influence of HC use on the hormonal genitourinary tract milieu.