- High blood pressure is more likely to strike women after menopause.
- A new study looks at how estrogen plays a part in that risk.
- Below, experts weigh in and discuss the pros and cons of estrogen hormone replacement therapy (HRT).
Did you know that high blood pressure (also known as hypertension) is more likely to strike women after menopause? That’s not just another weird menopause symptom to mark down—it’s pretty serious, especially because heart disease is the number one killer of women in the United States. Experts are looking into the relationship between menopause and hypertension, and there’s still a lot to learn. However, one factor that is believed to have an impact is low estrogen and the disappearance of the hormone altogether.
Meet the Experts: Sheryl Ross, M.D., board-certified ob/gyn at Providence Saint John’s Health Center in Santa Monica; and Cheng-Han Chen, M.D., board-certified cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA.
Menopause is marked by the downward turn, and eventual cessation, of estrogen production, which is crucial to lots of bodily processes, including blood circulation. “Estrogen production helps maintain and protect elasticity in the blood vessels, reduces LDL or ‘bad’ cholesterol and promotes HDL or ‘good’ cholesterol production,” explains Sheryl Ross, M.D., board-certified ob/gyn at Providence Saint John’s Health Center in Santa Monica. “Losing these heart health benefits during menopause increases the risk of cardiovascular disease in menopausal women.”
A new study takes a closer look at how estrogen impacts physiological and hormonal pathways, how those processes change after menopause, and how those changes may impact heart health. Below, Dr. Ross and a cardiologist share their thoughts on the findings.
What did the study find?
The study, published in Mathematical Biosciences, used a computer-run mathematic model to conduct simulations of blood pressure regulation in post-menopausal women. As women aged, hypertension probability went up, and estrogen appeared to play a part.
The model also predicted that certain types of blood pressure medications (angiotensin receptor blockers) are more effective than others (angiotensin converting enzyme inhibitors) in treating hypertensive women as estrogen levels decline. Researchers didn’t make direct claims about how supplemental estrogen in the form of hormone replacement therapy (HRT) may help, but experts say there is potential there.
“Estrogen has a positive influence on almost every organ system in the body,” says Dr. Ross. “This study supports the protective effect of estrogen on the vascular system, blood pressure, and, ultimately, cardiovascular disease, before and after, the menopause transition.”
She continues: “Taking estrogen therapy can help by bringing back some of the benefits of elasticity and dilation of blood vessels, reducing LDL levels and promoting HDL levels, which support heart health. It’s suggested to start estrogen therapy as you enter menopause for optimal cardiovascular benefits.” Cheng-Han Chen, M.D., board-certified cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA adds that estrogen is also known to lower inflammation in the body.
Of course, there are many contributing factors to cardiovascular disease risk, including lifestyle, family history, and genetics, Dr. Ross notes. HRT is just another layer to consider. More research is needed to determine whether estrogen could be deemed a full-on blood pressure treatment in menopausal women.
Right now, Dr. Chen says the evidence is mixed, and it varies greatly depending on the HRT formulation. “Some studies show that transdermal [skin-absorbed] estrogen can help to regulate blood pressure in post-menopausal women, however, oral estrogen appears to increase the risk of developing high blood pressure,” he notes.
What is estrogen HRT?
HRT is primarily prescribed—in creams and in oral medications—as a treatment for unmanageable menopause symptoms, “including hot flashes, night sweats, sleep problems, vaginal dryness, burning and pain with or without sex, frequent bladder infections, brain fog, depression, fatigue and loss of libido,” says Dr. Ross. But, as we’re learning, it could have some secondary benefits—even in addition to heart health.
“The secondary benefits of HRT, especially when taken during the first 10 years of going into menopause, are that it improves metabolic health by regulating insulin production, maintaining body weight and fat distribution, and reducing the risk of type 2 diabetes,” says Dr. Ross. “These benefits support and improve hormonal balance, cardiovascular, and metabolic health.”
The bottom line
“All menopausal and post-menopausal women should talk to their doctors about the benefits and risks of HRT, including those at risk for heart disease,” says Dr. Ross. “The secondary benefits on heart disease should never be minimized.”
She concludes: “Taking HRT and blood pressure medications may interact negatively when taken together, depending on if you are in perimenopause or menopause. Since blood pressure medications help to improve blood flow through blood vessels, and estrogen have similar effects, these medications should be discussed with your healthcare provider team to know if any changes should be considered.”
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