WASHINGTON — Women often use hormone therapy to relieve hot flashes and other menopause symptoms — and new research suggests patches or creams may be safer for their blood pressure than pills.
As the levels of female reproductive hormones decrease during menopause, women are at greater risk of heart disease. High blood pressure further increases that risk — but it’s not clear whether there’s a link with hormone therapy for menopause symptoms.
Canadian researchers wondered if the way hormones are absorbed — orally, vaginally or through the skin — could play a role.
The University of Calgary team examined health records of more than 112,000 women ages 45 and older who filled prescriptions for at least six months’ worth of estrogen-only hormone treatment between 2008 and 2019. The researchers tracked the women who developed high blood pressure a minimum of a year following treatment.
While the differences weren’t huge, women who took estrogen pills had a 14% higher risk of developing hypertension compared to those using skin patches or creams, the researchers reported Monday. Oral estrogen carried a 19% greater risk than vaginal versions.
The results were published in Hypertension.
Hormone therapy has a mix of risks and benefits that mean it’s not for everyone. It’s not prescribed to treat disease, but rather to alleviate menopause symptoms. The lowest dose is usually used for the least amount of time. Most commonly used are combination pills of estrogen and another hormone, progestin. (Estrogen-only pills typically are prescribed to women without a uterus. )
Different versions of hormone therapy may work better for different menopause symptoms, something the study didn’t address.
But the study adds valuable clues in understanding the complicated relationship between hormonal therapy and blood-pressure, according to Dr. Garima Singh, a woman’s heart expert with Virginia’s Inova Health System, and the American Heart Association.
Sharma would like to see a more rigorous trial that compares different hormone versions. But she pointed to a possible biological explanation: Maybe oral estrogen affects enzymes linked to blood pressure as it’s being processed, while skin and vaginal versions have much more limited activity in the body.
Still, “these findings are very clinically relevant,” Sharma said in an an email, and suggest it’s especially important to monitor blood pressure in women who use oral hormone therapy.
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