A Pill for Stress Leaks?What the Data on Duloxetine Show About Benefits and Side Effects

Unlike urge leaks, stress leaks (leaking with coughing, sneezing or exercise) have few medicine options. Duloxetine, an antidepressant also used for nerve pain, is approved in Europe for stress leaks in women.¹ Here’s how it performed when independent researchers examined the full trial reports.

What the trials showed

Researchers obtained thousands of pages of clinical study reports, including individual patient data, from four placebo-controlled trials with about 1,900 women.¹

Benefits:

• Weekly leaks dropped about 14 percentage points more than with placebo.¹
• Quality of life scores improved, but the effect sizes were small.¹
• About 1 in 8 women rated themselves “much better” because of duloxetine rather than placebo.¹

Harms:

• About 1 in 7 stopped because of side effects.¹
• About 1 in 7 had “activation” effects such as insomnia, anxiety or agitation.¹
• No suicidal or violent events were seen in these reports.¹

The authors concluded that the harms outweighed the benefits.¹

An earlier meta-analysis also found more improvement with duloxetine than placebo, but side effects such as nausea, constipation, dry mouth and fatigue were common.²

What tends to come first

For stress leaks, options with less risk of body-wide side effects include:

• Pelvic floor muscle training, ideally with a physical therapist. See pelvic floor exercises and pelvic floor therapy costs.
• A continence pessary. See our pessary guide.
• Bulking injections or a sling. See bulking injections and sling routes.
• Weight loss for women with overweight. See the PRIDE trial.

Try: “I leak when I cough and I’d rather avoid surgery. Is duloxetine worth considering for me, or should I try pelvic floor therapy or a pessary first?”

Laugh, Sneeze, Jump includes an appointment prep sheet. Use it to record how often you leak and which activities trigger it before discussing treatments.