Estrogen Therapy Route Linked to Hypertension Risk in Postmenopausal Women

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Menopause is a natural biological process that marks the end of a woman’s reproductive years. Typically occurring in their late 40s or early 50s, menopause brings about physical and emotional changes as the ovaries gradually stop producing eggs and hormone levels fluctuate.

Various symptoms, including hot flashes, night sweats, mood swings, vaginal dryness, and sleep disturbances often accompany this significant transition in a woman’s life. While menopause is a natural phase, it can significantly impact a woman’s well-being and quality of life. Understanding the complexities of menopause and its associated challenges is crucial in providing support and appropriate management for women experiencing this transformative stage of life. 

A large new study published in Hypertension and reported by US News suggests that menopausal women who use estrogen to ease their symptoms may experience a rise in blood pressure. Still, how they take the hormone could determine the extent of the increase. The study, which involved over 100,000 menopausal women on estrogen therapy, found that oral pills significantly affected blood pressure more than estrogen delivered through skin patches, gels, or vaginal preparations.  

However, experts emphasize that the increased risk is modest and should not cause concern among women already taking oral estrogen without any problems. The researchers highlight the importance of considering blood pressure when deciding on the type of hormone therapy best suited for each woman.  

Hormone therapy is commonly used to treat troublesome symptoms of menopause, such as hot flashes and night sweats, by compensating for the loss of estrogen. However, this therapy has been associated with certain health risks, including an increased likelihood of blood clots, stroke, and breast cancer. The relationship between hormone therapy and heart health is complex, as starting therapy at a younger age or within ten years of menopause may not adversely affect the heart.  

Previous studies have suggested that applying estrogen to the skin, typically through patches or gels, may carry less risk than taking it orally. Despite this, most women still opt for oral estrogen due to cost considerations.Dr. Stephanie Faubion, medical director of the North American Menopause Society, advises women with risk factors for heart disease and stroke, such as obesity, diabetes, and high blood pressure, to opt for skin-delivered hormone therapy over tablets. When estrogen is taken orally, it goes through the liver first.

At the same time, the skin route avoids this initial passage through the liver, potentially reducing the hormone’s effects on blood clotting, triglycerides, and blood pressure. The new study analyzed data from over 112,000 Canadian women aged 45 and older who used estrogen-only hormone therapy between 2008 and 2019. Most women in the study used non-oral forms of estrogen, and overall, they had a lower risk of newly diagnosed high blood pressure than women on oral estrogen.

The duration of estrogen therapy also appeared to play a role, with a longer duration associated with a higher risk of developing high blood pressure. However, this link was observed regardless of the route of use, and the researchers suggest that it may be due to menopausal symptoms rather than hormone therapy.  

Dr. Ahmed, the senior researcher, and Dr. Faubion emphasize the importance of personalized hormone therapy. They recommend that women and their doctors have a comprehensive discussion considering not only menopause symptoms but also cardiovascular health, bone health, family history, and quality of life preferences.

The individualized approach involves evaluating risks and benefits and adjusting therapy based on the woman’s needs. The previous standard advice of using the lowest dose and shortest duration of hormone therapy necessary to alleviate symptoms has evolved into a more tailored approach. 



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