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According to a study published in the journal “Hypertension,” oral estrogen administered through pills might be linked to an elevated risk of high blood pressure in comparison to vaginal creams and transdermal patches.
The study drew on health administrative data from medical records in Alberta, Canada, involving 112,000 women aged 45 and above, all of whom obtained at least two consecutive prescriptions for estrogen-only hormone therapy. The researchers outlined three distinct approaches for administering the medication: oral, transdermal, and vaginal.
The presence of high blood pressure in each woman was determined based on their health records.
Medical professionals emphasize that the transition through menopause can lead to various health concerns, such as hypertension, particularly among older women.
It’s advised that women’s cardiac health be closely observed as they navigate the stages of menopause.
Details from the Estrogen and Hypertension Study
Key findings from the estrogen and hypertension study:
After a minimum of one year following the initiation of treatment, researchers examined the correlation between the method of estrogen-only hormone therapy administration and the likelihood of developing high blood pressure.
The outcomes revealed:
- Women who underwent oral estrogen therapy exhibited a 14% elevated risk of high blood pressure development in comparison to those utilizing the transdermal patch.
- Women on oral estrogen therapy displayed a 19% heightened risk of high blood pressure compared to those utilizing vaginal estrogen creams.
- The correlation was notably more pronounced among women below the age of 70 compared to those aged 70 or above.
- In contrast to estradiol, the utilization of conjugated equine estrogen was linked to an 8% greater risk of high blood pressure development.
- The likelihood of developing high blood pressure was heightened with prolonged duration of estrogen use or higher dosage.
Dr. Monte Swarup, FACOG, a practicing OB/GYN based in Chandler, Arizona, and the founder of the HPV information platform HPV HUB, commented on the study’s outcomes: “The study highlights that oral estrogen is associated with a higher incidence of hypertension compared to transdermal or vaginal methods.”
Dr. Swarup, who was not directly involved in the research, added, “Women using estrogen hormone replacement therapy should undergo vigilant monitoring for hypertension. Orally administered estrogen undergoes a first-pass effect, passing through the liver before entering the general circulation. According to the study, any form of estrogen apart from oral administration is preferable, as it is linked to a lower association with hypertension.”
Menopause and women’s health
Medical professionals emphasize the significance of examining the comprehensive impact of menopause on women.
“We are aware that severe and prolonged menopausal symptoms, including vasomotor symptoms, can heighten cardiovascular risk, leading to compromised quality of life, disrupted sleep, and feelings of depression or anxiety. It’s crucial for women to understand that enduring these symptoms is unnecessary, and there are numerous treatment choices accessible to them,” stated Dr. Anais Hausvater, a cardiologist specializing in women-centric cardiovascular diseases at NYU Langone Heart in New York.
Hausvater, who was not part of the study, further noted, “This study underscores the overall safety of hormone therapy involving estrogen, particularly when administered vaginally or transdermally. For individuals potentially predisposed to hypertension due to factors like obesity, metabolic syndrome, or a history of hypertensive disorders during pregnancy, transdermal or vaginal estrogen creams could be a more secure alternative.”
Experts highlight that the study’s findings derive from a cohort study, which may not offer as precise data as a study involving participants who are recruited, exposed to various estrogen forms, and subsequently monitored for their effects.
“A cohort study is retrospective,” elucidated Dr. G. Thomas Ruiz, the lead OB/GYN at MemorialCare Orange Coast Medical Center in California.
Ruiz, also not affiliated with the study, further explained, “In essence, scientists identify individuals meeting specific criteria for this type of study. In this instance, they identified women who had used estrogen and then explored the type of estrogen and its connection to high blood pressure. This sort of study provides information, but it doesn’t equate to a real-time investigation.”
High blood pressure during menopause
The different stages of menopause can influence blood pressure in various manners.
A study conducted in 2015 indicated that despite the scarcity of research on blood pressure during perimenopause, there seems to be an escalating prevalence of hypertension as women progress through this phase.
A 2021 statement by a consortium of European cardiologists, gynecologists, and endocrinologists proposed that medical professionals could sometimes overlook high blood pressure among middle-aged women, attributing the symptoms to stress or menopause. They pointed out that this oversight could result in delayed diagnosis and treatment, amplifying the risk of heart failure and stroke.
Given that hypertension often lacks noticeable symptoms, it’s often referred to as the “silent killer.” Diagnosis can also be challenging during annual doctor’s office visits for women.
“A blood pressure reading of 135/90 might be dismissed as anxiety,” explained Ruiz. “However, consistent readings of 135/90 could signify hypertension. It’s advisable to schedule a follow-up appointment within six weeks. I also recommend that women acquire a home blood pressure monitor, take measurements at different times, and then average them for a more accurate assessment. Alternatively, many smartwatches or activity trackers can provide blood pressure readings. Women can keep track of their readings, and we can analyze them during follow-up appointments.”
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