# Stress Urinary Incontinence (Female Adult) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) · YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) - Verified date: 2026-08 ## Verified against - Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) - YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) - Stress Urinary Incontinence - disease-level clinical article (urinary-incontinence-stress-full.txt) - Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) ## Treatment metadata - Duloxetine — 40 mg — oral.solid - Referral & safety-netting (no drug therapy) - Estriol — topical ## Complete treatment card ```text STRESS URINARY INCONTINENCE (FEMALE ADULT) Sources: Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) · YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) Review status: REVIEWED against Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869), YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441), Stress Urinary Incontinence - disease-level clinical article (urinary- incontinence-stress-full.txt), Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Leakage confined to coughing, sneezing, laughing, or physical effort defines the stress- incontinence pattern [cough · sneezing · urinary incontinence] - Menopausal status and hypoestrogenism are checked as contributors during history-taking - Rising use of pads, tampons, or diapers day to day tracks how severe the leakage has become SIGNS - what you find (3) - A positive cough stress test subjectively confirms stress incontinence on exam [cough · urinary incontinence] - Cystocele, rectocele, or uterine prolapse on pelvic exam are signs of pelvic relaxation [genital prolapse] - Prolapse extending past the hymen can mask or blunt how severe the stress leakage appears [genital prolapse] TESTS (5) - A cotton-swab (Q-tip) deflection of 30 degrees or more on straining defines urethral hypermobility - A maximum urethral closure pressure under 20 cm of water points to intrinsic sphincter deficiency - Leakage on Valsalva at a bladder pressure of 60 cm of water or below indicates intrinsic sphincter deficiency - Postvoid residual volume is measured as a standard part of the initial work-up - Urodynamics are not needed to work up straightforward, uncomplicated stress leakage IF NOT THIS - what else fits (5) - Genitourinary syndrome of menopause, driven by estrogen deficiency, can mimic stress-type leakage - Stroke, multiple sclerosis, Parkinson disease, or a spinal cord injury are neurologic differentials for this presentation - Overflow incontinence presents as continuous dribbling from urinary retention rather than effort-triggered leakage - Urge incontinence involves a sudden, hard-to-defer urge rather than leakage tied to physical effort - A pelvic mass pressing on the bladder can produce similar leakage Source StatPearls "Stress Urinary Incontinence" - disease-level clinical article Status traced to the source above 1. DULOXETINE [1st line] Adult 40 mg twice daily; re-evaluate after 4 weeks Peds Not indicated in children Source YENTREVE ® 20 mg hard gastro-resistant capsules YENTREVE ® 40 mg hard gastro-resistant capsules SmPC section 4.2 Posology and method of administration (eMC product 7441) Why Serotonin-noradrenaline reuptake inhibitor that increases pudendal nerve input to the urethral sphincter, improving sphincter tone and closure; used for stress urinary incontinence when first-line pelvic floor muscle training has not been sufficient. Caution Pelvic floor muscle training (PFMT) for at least 3 months is FIRST-LINE conservative therapy. Nausea, dry mouth, insomnia, and dizziness are common during initiation; taper when discontinuing. Contraindicated in uncontrolled hypertension and liver disease resulting in hepatic impairment. The indication is on two documents now. The condition's own article has duloxetine raising the tone of the external urethral sphincter and cutting stress incontinence episodes markedly in as many as 64% of patients. The general urinary incontinence article names it under the pharmacologic management of stress incontinence, alongside vaginal estrogen cream. The same article's own reservation: outside Europe it judges the balance of benefit against risk for duloxetine in stress urinary incontinence to be unfavourable, Europe being where the drug is approved for moderate to severe cases. Weigh that before starting it, and it is why the drug is not FDA-approved for this use. Egypt DEPRETREVE 20MG 20 CAPS. INTERNATIONAL... 62.00 EGP (3.10/unit) -> ? strength differs DULOPRESSIVE 20 MG 30 CAPS. GLOBAL NAPI P... 112.00 EGP (3.73/unit) -> ? strength differs DEPRETREVE 30MG 20 CAPS. INTERNATIONAL... 86.00 EGP (4.30/unit) -> ? strength differs KARBALTA 30 MG 28 CAPS. MASH PREMIERE 212.00 EGP (7.57/unit) -> ? strength differs KARBALTA 60 MG 30 CAPS. MASH PREMIERE 249.00 EGP (8.30/unit) -> ? strength differs CYMBALTA 30 MG 28 CAPS. ELI LILLY 399.00 EGP (14.25/unit) -> ? strength differs DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS. ZETA PHARMA 231.00 EGP -> ? strength differs WADILOXTIN 60 MG 28 DEL. REL. CAPS. WADI ELNEEL BENTA 280.00 EGP -> ? strength differs 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Stress Urinary Incontinence - disease-level clinical article (urinary-incontinence- stress-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Refer to a urogynaecologist or urologist for: unexplained haematuria; recurrent UTIs; incontinence that is unusually severe, or that has not responded to medical treatment; marked bladder overactivity; prolapse, or pelvic anatomy that is abnormal; a neurological condition alongside it; previous surgery for incontinence, other significant pelvic surgery, or pelvic radiotherapy; and any case where the diagnosis is in doubt or urodynamic testing came back equivocal. 3. ESTRIOL [add-on - not a substitute] Adult One applicatorful (0.5 mg estriol) intravaginally once daily at bedtime; maintenance dose of one applicatorful twice a week may be used after restoration of the vaginal mucosa has been achieved Peds Not indicated in children Source Gynest 0.01% w/w Cream (estriol) SmPC sections 4.2 and 4.4 (eMC product 5869) Why Adjunct topical oestrogen added when stress incontinence occurs alongside postmenopausal vaginal atrophy, restoring urogenital tissue integrity; it treats the atrophic component and does not replace pelvic floor training or duloxetine. Caution Systemic absorption is minimal; systemic progestogen co-prescription is not required for vaginal estriol cream. The cream perishes rubber. A latex condom or diaphragm that has been in contact with it cannot be relied on for contraception. Review it yearly and try stopping every three to six months rather than repeating indefinitely. Breakthrough bleeding or spotting that starts on treatment, or carries on after stopping, needs investigating - biopsy included - to rule out endometrial cancer. Indicated for treatment of atrophic vaginitis and kraurosis in postmenopausal women. The indication is on two documents now. The condition's own article finds local topical estrogen of benefit to the postmenopausal woman with stress incontinence. The general urinary incontinence article names vaginal estrogen cream under the pharmacologic management of stress incontinence. The article's own frequency differs from the daily regimen the label sets: it describes a protocol in common use of 1 g or less per vaginal application, given 2 or 3 times a week. The dose printed here is the Gynest label's, which is the document that states a strength; the article's frequency is recorded so the difference is visible rather than hidden. Egypt OVESTIN 1 MG 20 TAB SEDICO > SCHE... 11.10 EGP (0.55/unit) -> ? different route - not topical Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)