Oral Estrogen Therapy Increases Hypertension Risk in Women

The average age of natural menopause among women worldwide is about 50 years, much younger than previously, and treating postmenopausal concerns has been problematic.

A woman’s body produces less oestrogen and progesterone after menopause, changes that may increase the risk for cardiovascular diseases, including heart failure, with previous studies showing that specific types of hormone therapy have been associated with higher rates of heart disease.

Three different routes of hormone therapy administration, oral, transdermal and vaginal application found that those taking oral oestrogen therapy had a 14% higher risk of developing high blood pressure compared to those using transdermal oestrogen and a 19% higher risk of developing high blood pressure compared to those using vaginal oestrogen creams or suppositories.

Compared to oestradiol, conjugated equine oestrogen was associated with an 8% increased risk of developing high blood pressure, yet it must be said that conjugated equine oestrogen is a somewhat older therapy with more contemporary solutions now available.

Researchers found that the longer the time or higher doses of oestrogen, the greater the risk of high blood pressure. However, a significant limitation of the study was with oestrogen-only therapy, with many treatments combining oestrogen and progestirone and a small study size in Canada.

Of course, this must be balanced with the essential benefits of hormone therapy, which include the treatment of typical menopausal symptoms. While not discounting HRT, the type, dose, and administration seem more critical than the replacement therapy.

The use of hormone replacement therapy (HRT) in women with appropriate indications is vital. Yet, hormone therapy should not be considered as prevention or treatment of hypertension or heart disease, as has been previously.

Ref: Kalenga, C. Z.,  Metcalfe, A., Robert, M., Nerenberg, K., MacRae, J., &  Ahmed, S. (2023) Association Between the Route of Administration and Formulation of Oestrogen Therapy and Hypertension Risk in Postmenopausal Women: A Prospective Population-Based Study. Hypertension, 80,1463–1473

Article submitted by Prof. Terry Everitt

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