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People taking estrogen-only tablets menopause A new study found that people using patches and creams were more likely to be diagnosed with high blood pressure. However, treating physicians menopause Estrogen-only tablets are rarely prescribed to high-risk patients, he said. overall benefits Limitations of hormone replacement therapy outsideWe weigh the risks for many patients.
hormone replacement therapy, Alternatively, HRT can be administered as estrogen alone, progesterone alone, or estrogen and progesterone to address menopausal symptoms such as hot flashes, chills, night sweats, sleep disturbances, mood changes, vaginal dryness, and pain during intercourse. increase. In most cases, progestin, a synthetic version of progesterone, is used for duplex formation.
A study found that menopausal women taking estrogen-only tablets were 14% more likely to be diagnosed with high blood pressure than those using estrogen-only patches. Those taking oral estrogen were 19% more likely to be diagnosed with high blood pressure than those using estrogen-only vaginal creams or suppositories.
“This is the largest study to include only women who take estrogen alone and have never taken progestin as an HRT,” said Sophia Ahmed, senior author of the study and professor of Medicine Cummings, University of Calgary, Canada. said Dr. .
When taken as a tablet, estrogen is primarily metabolized in the liver, where the hormone becomes inactive and is excreted from the body via urine and feces. When applied as a patch to the skin, estrogen enters the bloodstream and bypasses the liver, whereas vaginal creams and suppositories are absorbed locally.
Still, this is all estrogen, so why would taking it orally make a difference?
Dr. Stephanie Fabion, director of the Mayo Clinic Women’s Health Center, said physicians treating menopause “do not take oral estrogen because estrogen passes through the liver and increases blood clot proteins and triglycerides, causing a slight increase in blood pressure.” I don’t use it anymore,” he said. Researchers in Jacksonville, Fla., were not involved in the study.
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Experts recommend discussing the pros and cons of oral estrogen versus patch or cream estrogen with your doctor.
“But we already knew this Research on women’s health initiatives, blood pressure was found to rise by 1-1.5 millimeters of mercury. It’s like your blood pressure goes from 128 to 129,” said Fabion, who is also the medical director. North American Menopause Association, A professional association that provides certification to menopause professionals.
“The North American Menopause Society recommends that women under the age of 60 who are symptomatic within the first 10 years of menopause should: The benefits still outweigh the risks” said Fabion. “Also, for women with risk factors, we try to minimize risk by using transdermal rather than oral administration to avoid first-pass metabolism through the liver.”
the study, published on monday The journal Hypertension examined the medical records of more than 112,000 Canadian women aged 45 and over who received estrogen-only hormone therapy for at least six months between 2008 and 2019. The majority of study participants used estrogen for more than that.than 3 years.
Routes of administration include oral, transdermal, vaginal and intramuscular. The route of administration was excluded from the study because few study participants used intramuscular estrogen.
Fifty-five percent of study participants used synthetic estradiol. Estradiol is the most potent and prevalent female hormone throughout a woman’s lifetime. Cleveland Clinic.
The other two are estetrol, which is produced only during pregnancy, and estrone, a weak estrogen that continues to be produced after menopause. Only 5% of those in the study used estrone as a method of hormone replacement.
Conjugated equine estrogens are one of the oldest forms of estrogen therapy and were used by 40% of study participants. 10+ estrogens In this version It is isolated naturally or synthetically from the urine of pregnant horses and has been marketed ever since. In the 1940s, it was sold under the brand name Premarin (PREgnant MARes’ urINe). There are many other brands on the market today.
The researchers then analyzed medical records to see which study participants had developed high blood pressure within two years. Not only are those taking oral estrogens at higher risk than those taking percutaneous or vaginal births, but those taking conjugated equine estrogens are more likely to be diagnosed with hypertension than those taking estradiol. The study found an 8% higher risk.
“We also found that the longer the duration of oral estrogen administration, the higher the likelihood of being diagnosed with hypertension or hypertension,” said lead study author Ahmed. Higher doses also come with greater risks, she noted.
Because medical records were used in the study, researchers could only analyze information collected by the attending physician, which introduced some serious limitations to the study, Ahmed said.
“We didn’t know if they were smokers, if they were sedentary or if they were very active, what their BMI[body mass index]was, and if they were obese,” Ahmed said. rice field. “All these factors play a role in determining the risk of developing hypertension.”
Samar El-Coudary, professor of epidemiology at the University of Pittsburgh School of Public Health, who was not involved in the study, said the lack of information on weight is particularly critical.
“BMI is the biggest risk factor for hypertension. The difference in blood pressure they found may simply be due to excess weight,” said Elle Coudary, lead author of the American Heart Association paper. 2020 guidelines About menopause and cardiovascular risk.
“We know that obesity can actually cause the ovaries to shut down in young women. In older women, adipose tissue produces more estrogen by converting testosterone to estrogen.” she said.
But the biggest problem with the study, she said, was that it couldn’t compare pills, patches, or vaginal injections with age-matched women who didn’t take any estrogen.
“Since this study did not include a non-estrogen control group, we cannot conclude that oral estrogen use alone is associated with an increased risk of high blood pressure in women,” El-Coudary said. rice field. “I can’t say that.”
A large randomized study “that takes into account all the complexities of hormone therapy around this critical transition in a woman’s life cycle” is needed, Ahmed said. “At the end of the day, what’s best for someone going through menopause is an individual decision and should be an open conversation with your doctor and health care team.”
