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Hormone replacement therapy (HRT) or menopausal hormone therapy is used to alleviate hot flashes and other symptoms of menopause. The most common method has been estrogen pills or oral formulations containing estrogen and progesterone. After menopause, a woman’s body produces less estrogen and progesterone. This is also an additional risk factor for cardiovascular diseases, including heart failure.
Study Background
Previous research has shown that certain hormonal medications can reduce the risk of cardiovascular diseases in women up to the age of 60. However, in other women, hormone therapy increased blood pressure, thereby increasing the risk of such conditions.
Canadian researchers posed whether the route of hormone administration – oral, vaginal, or transdermal – could play a role.
We know estrogens ingested orally are metabolized through the liver. This is associated with an increase in factors that can lead to higher blood pressure. We chose to dive deeper into factors associated with hormone therapy, such as the route of administration (oral vs. non-oral) and type of estrogen, and how they may affect blood pressure.
Cindy Kalenga, lead study author, M.D./Ph.D.-candidate at the University of Calgary in Alberta, Canada
Methodology
The team from the University of Calgary studied medical records of over 112,000 women aged 45 and older from 2008 to 2019. These women were prescribed at least six months of hormone therapy containing estrogen alone. The researchers tracked which women developed high blood pressure for at least a year after starting the treatment.
Three different methods of hormone therapy administration were examined: oral, transdermal, and vaginal.
Local Estrogen Formulations Were Found to Be Safer than Estrogen Pills
Women taking estrogen in pill form had a 14% higher risk of developing hypertension compared to those using patches or creams. Oral estrogen also carried a 19% higher risk than the vaginal option.
Currently, experienced specialists recommend initiating hormone therapy for menopause symptom relief as early as possible and for the shortest duration. Now, researchers have observed that the method of administration also matters. They also note that the currently safest form is estradiol – a synthetic form of estrogen that most accurately mimics its natural form.
Over a quarter of the world’s population of women are currently older than the age of 50. By 2025, it’s estimated that there will be one billion menopausal individuals on the planet. Approximately 80% of people going through menopause have symptoms, and for some it lasts up to seven years. While menopause is a normal part of the aging process, it has huge implications for quality of life, economic impact, work productivity and social relationships. We need to give people the information they need to choose the most effective and safe hormonal treatments for menopause.
Study co-author Sofia B. Ahmed, M.D., M.M.Sc., a professor of medicine at the University of Calgary, Alberta, Canada
The authors will conduct further research investigating the combination of estrogen and progesterone. Additionally, they plan to examine different forms of progestin in hormone therapy and its impact on heart and kidney diseases. At the same time, scientists emphasize that hormone therapy should be prescribed individually based on appropriate indications. It should never be considered as a preventive measure or treatment for hypertension and heart diseases.
