Friday, March 24, 2023

Estrogen Replacement High Blood Pressure

What Causes These Changes

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People who are going through menopause experience a significant drop in the hormone estrogen. This hormone has a beneficial effect on blood pressure.

Firstly, estrogen has a vasodilative effect, meaning it helps promote blood flow by keeping the blood vessels open. Secondly, estrogen helps keep cholesterol levels low, and this helps prevent the narrowing and hardening of the arteries due to cholesterol deposits or plaques. As such, a person experiencing decreased estrogen levels as a result of menopause may be at increased risk of developing hypertension.

People who are going through menopause may also experience weight gain. Being 20 pounds or more overweight can increase the risk of high blood pressure, so menopause can inadvertently contribute to this risk.

According to a 2014 review, some studies have shown that people who have experienced menopause are more sensitive to salt than those who have yet to go through menopause. Sensitivity to salt can mean that there is excess salt in the bloodstream. Excess salt increases fluid retention, and this increases blood pressure.

What To Do If You Have High Blood Pressure And Menopause Symptoms Visit Herkare

Our providers at HerKare take a holistic approach to healthcare. If youre experiencing menopause symptoms, high blood pressure, or other conditions, make an appointment at one of our clinics. We offer personalized treatment solutions to help you feel your best. Our team works with you to find treatment solutions that work for you. For instance, if you have both high blood pressure and menopause symptoms, we may recommend a combination of lifestyle changes, bioidentical hormone therapy, blood pressure medications to address your whole health. Get in touch to learn how we can help you feel better again.

Data From Clinical Trials

The effects of discontinuing HRT have also been investigated. Zarifis et al. reported that hypertensive women in whom HRT was discontinued for various reasons exhibited no change in systolic or diastolic blood pressure after the preparations were stopped. Also at issue is whether or not oestrogen alone or oestrogen combined with a second preparation have similar effects on blood pressure. Jespersen observed that artificial oestrogens combined with progestogens increased blood pressure, while genuine oestrogens did not, even when used in combination. In the United States, Premarin® is a commonly employed mixture of conjugated oestrogens obtained from the urine of pregnant mares. According to Jespersen , this preparation also increases blood pressure. Wong et al. demurred in their report that involved the treatment of 25 hypertensive postmenopausal women who received 0.625mg Premarin®. They observed no increases in blood pressure with this preparation.

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How Progesterone Replacement Therapy Affects Blood Pressure

In the past, many believed that both the female hormones estrogen and progesterone increased blood pressure. This was because many women taking hormone-based birth control and hormone replacement therapy for menopause experienced high blood pressure as a side effect. However, recent research shows that estrogen is the likely culprit for increased blood pressure. Progesterone, by contrast, may have the opposite effect. As a natural diuretic, progesterone may actually lower blood pressure for some women.

Progesterone replacement therapy is often paired with estrogen to treat menopause symptoms. Every patient who still has a uterus is prescribed progesterone alongside estrogen. This is because progesterone helps prevent the uterine lining from becoming too thick, increasing the risk for endometrial cancer. Therefore, in the past many researchers had difficulty separating the effects of progesterone and estrogen for women taking both at the same time. However, progesterone replacement therapy on its own is getting more and more attention. For example, some studies have found progesterone-only therapy may help with menopausal hot flashes.

Effects Of Estradiol On Circulating Factors

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Estradiol modulates the synthesis of circulating factors known to influence vascular tone and structure. For example, estradiol increases bradykinin levels and may lower blood pressure by increasing bradykinin synthesis . Estradiol down-regulates the expression of angiotensin converting enzyme in serum as well as in the vasculature and decreases renin release and Ang II formation . These effects are in some respects paradoxical since estradiol stimulates angiotensinogen expression in the liver . Ang II is a potent mitogen for vascular smooth muscle cells and induces vascular remodeling processes associated with hypertension. Therefore, the inhibitory effects of estradiol on the reninangiotensin system may lead to reduced vascular growth. Estradiol also down-regulates the expression of Ang II type 1 receptors in smooth muscle cells . Since these receptors mediate the mitogenic effects of Ang II, estradiol may abrogate the effects of Ang II in part via this mechanism. Our own studies show that estradiol inhibits Ang II-induced growth of human smooth muscle cells in vitro , thus supporting this concept. Additionally, estradiol induces the synthesis of Ang 17, a vasodilator and smooth muscle cell growth inhibitor .

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A Change In Recommendations

These studies were the first large-scale trials that looked for cause and effect with heart disease and HRT. HRT does offer some benefits, such as preventing osteoporosis and reducing the risk of colon cancer. But the data on heart-related risks from these studies were very compelling. As a result, the American Heart Association and the U.S. Food and Drug Administration developed new guidelines for the use of HRT:

  • HRT should not be used for prevention of heart attack or stroke.
  • Use of HRT for other problems such as preventing osteoporosis should be carefully considered and the risks weighed against the benefits. Women who have existing coronary artery disease should consider other options.
  • HRT may be used short-term to treat menopausal symptoms.
  • Long-term use is discouraged because the risk for heart attack, stroke and breast cancer increases the longer HRT is used.
  • The bottom line, say physicians at the Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic: weigh the benefits of HRT against the risks and discuss the whole subject of HRT with your physician to be able to make an informed decision.

    New Study Suggests Link Between Estrogen Blood Pressure

    EAST LANSING, Mich. While recent studies have shown long-term exposure to estrogen can be a danger to women overturning physicians long-held beliefs that the hormone was good for their patients hearts the process by which estrogen induces high blood pressure was unclear.

    In a new study, Michigan State University researchers found long-term estrogen exposure generates excessive levels of the compound superoxide, which causes stress in the body. The buildup of this compound occurs in an area of the brain that is crucial to regulating blood pressure, suggesting that the estrogen-induced buildup causes increased blood pressure.

    Findings indicated that the anti-oxidant resveratrol reverses the increase in both superoxide and blood pressure.

    The study, led by P.S. MohanKumar, an associate professor of pathobiology and diagnostic investigation in the College of Veterinary Medicine, appears in the American Journal of Physiology Regulatory, Integrative, and Comparative Physiology. The journal is published by the American Physiological Society.

    This is an important study on at least two levels, MohanKumar said. First, it continues to confirm the negative effect that long-term estrogen exposure has for females. Second, it provides a new rationale for how and why this relationship occurs.

    The abstract of the article is available at , while the full study appears at .

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    Why Is This Medication Prescribed

    Combinations of estrogen and progestin are used to treat certain symptoms of menopause. Estrogen and progestin are two female sex hormones. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat , vaginal symptoms and difficulty with urination, but it does not relieve other symptoms of menopause such as nervousness or depression. Estrogen also prevents thinning of the bones in menopausal women. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus.

    Strengths And Limitations Of The Study

    Estrogen on TRT & Steroids

    The key strength of our study was the large sample size, which enabled us to test whether MHT use and duration of MHT use was associated with high blood pressure. It confirms cross-sectional baseline results from the WHI, and extends these findings by showing that both past and current users of MHT have higher odds of having high blood pressure, and that the association between MHT use and high blood pressure is higher in younger, postmenopausal women. Furthermore, this is the first report that the longer a woman uses MHT the higher her odds for having high blood pressure, and is retained irrespective of when MHT was initiated relative to menopause, or the number of years since ceasing MHT treatment.

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    Post Menopausal Hormon Replacement Therapy

    How prevalent is heart disease among women?

    Female Reproductive Organs

    Cardiovascular disease is NOT just a mans disease. Cardiovascular disease is the Number 1 killer of women over age 25 in the United States, regardless of race or ethnicity. Once a woman reaches the age of 50 , the risk for heart disease increases. In young women who have undergone early or surgical menopause, the risk for heart disease is also higher, especially when combined with other risk factors such as:

    • Elevated LDL cholesterol
    • Low HDL cholesterol, sometimes called “good” cholesterol
    • Family history of heart disease

    What is menopause?

    Technically, menopause is the end of a womans reproductive cycle, when the ovaries no longer produce eggs and she has her last menstrual cycle. The diagnosis of menopause is not confirmed until a woman has not had her period for six to twelve consecutive months.

    Menopause usually occurs naturally in women between ages 45 and 55 . However, loss of estrogen can also occur if the ovaries are removed during surgery or if a woman goes through early menopause.

    How is heart disease associated with menopause?

    • Estrogen helps a younger womans body protect her against heart disease.
    • Changes in the walls of the blood vessels, making it more likely for plaque and blood clots to form.
    • Changes in the level of lipids in the blood occur.
    • An increase in fibrinogen . Increased levels of blood fibrinogen are related to heart disease and stroke.

    Effects Of Estradiol On Vascular Tone

    Functional estrogen receptors of the and subtypes are expressed in vascular endothelial and smooth muscle cells , and it is well established that estradiol can cause vasodilation by both ER-dependent and ER-independent mechanisms. Acute administration of estradiol in vitro and in vivo induces rapid dilation of coronary arteries of cholesterol-fed ovariectomized animals . Exogenous estradiol also dilates coronary and brachial arteries in postmenopausal women and men . Long-term treatment with estradiol abrogates the vasoconstrictor effects of U46619 , phenylepinephrine, 5-HT, calcium, potassium and acetylcholine on vascular tissues such as aortic rings and coronary arteries . Compared with premenopausal women, vasodilator effects of estradiol are decreased in postmenopausal women and are normalized by estrogen replacement therapy . The vasodilator effect of estradiol replacement therapy is diminished by co-administration of synthetic progestins such as medroxyprogesterone and cyproterone acetate .

    In summary, estradiol is a vasodilator that decreases vascular resistance by multiple mechanisms. Increased production of NO plays a prominent role, and increased synthesis of other endogenous vasodilators, decreased synthesis of endogenous vasoconstrictors and activation of K+ channels also contribute to the vasodilatory actions of estradiol.

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    Study Finds High Blood Pressure Linked To Loss Of Estrogen In Peri

    Estrogen receptor beta neurons in the brain are important for blood pressure regulation in a mouse model of human perimenopause. Credit: Image courtesy of Dr. Milner.

    Women become more susceptible to hypertension as they approach menopause, and now a preclinical study led by researchers at Weill Cornell Medicines Feil Family Brain and Mind Research Institute suggests that this perimenopausal hypertension may be driven by declines in estrogen signaling in a brain region called the hypothalamusand may be preventable with estrogen-like treatments.

    In the study, published May 3 in the Journal of Neuroscience, the researchers, led by Drs. Teresa Milner and Michael Glass, respectively a professor and associate professor of neuroscience in Weill Cornell Medicines Feil Family Brain and Mind Research Institute, used mice to model the perimenopausal decline in the production of estrogen by the ovaries.

    The scientists found that female mice with a low-estrogen condition resembling human perimenopause become more susceptible to experimentally induced hypertensionbut lose that susceptibility when estrogen signaling is boosted again with an estrogen receptor -stimulating agonist drug.

    The results, say the researchers, suggest that ER agonists might be beneficial in preventing or treating hypertension in perimenopausal women.

    How To Get Started On Hrt

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    Speak to a GP if you’re interested in starting HRT.

    You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first.

    A GP can explain the different types of HRT available and help you choose one that’s suitable for you.

    You’ll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some side effects at first.

    A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT you’re taking.

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    What Other Information Should I Know

    Keep all appointments with your doctor and the laboratory. You should have a complete physical exam, including blood pressure measurements, breast and pelvic exams, and a Pap test at least yearly. Follow your doctor’s directions for examining your breasts report any lumps immediately.

    If you are taking hormone replacement therapy to treat symptoms of menopause, your doctor will check every 3 to 6 months to see if you still need this medication. If you are taking this medication to prevent thinning of the bones , you will take it for a longer period of time.

    Before you have any laboratory tests, tell the laboratory personnel that you take hormone replacement therapy, because this medication may interfere with some laboratory tests.

    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

    It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Effects Of Estradiol On The Kidney

    The kidneys play a major role in the regulation of blood pressure, and renal abnormalities are involved in the development and maintenance of hypertension. As pointed out repeatedly by Guyton et al. , the common defect in hypertension is a shift to the right in the pressure-natriuresis relationship . This contention is strongly supported by the experimental evidence that transplantation of prehypertensive kidneys from SHR to WistarKyoto rats and from Dahl salt-sensitive to salt-resistant rats produces hypertension . Moreover, blood pressure is normalized in hypertensive humans transplanted with kidneys from normotensive donors .

    Gender-associated differences in renal hemodynamics and renal responses to Ang II are well established. In single nephrons, GFR and glomerular plasma flow are higher and preglomerular resistance is lower in male compared with female rats despite similar numbers of glomeruli per kidney . A reduction in preglomerular resistance is associated with increased glomerular injury, particularly if there is a concomitant increase in systemic BP.

    In addition to increased production and deposition of extracellular matrix proteins, increased proliferation of mesangial cells play a key role in glomerulosclerosis. Estradiol inhibits mitogen-induced proliferation of human glomerular mesangial cells , suggesting that it may protect against glomerular remodeling by inhibiting mesangial cell growth.

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    Blood Pressure The Menopause And Hrt

    We caught up with GP and menopause specialist Dr Louise Newson on the changes to your hormones that happen during the menopause and how HRT could help even if you have high blood pressure

    Female sex hormones such as estrogen play vital roles in our bodies, so its surprising how little most of us know about them. Blood Pressure UK caught up with GP and menopause specialist Dr Louise Newson on what you need to know about your hormones, the changes that happen at menopause, and how hormone replacement therapy could help even if you have high blood pressure.

    Go straight to ‘Can you take HRT if you have high blood pressure?

    Why do women need to know about their female sex hormones?

    We have other sex hormones including progesterone and testosterone which play their roles too, and can affect your mood and energy levels.

    During the menopause, our ovaries stop making these hormones. This causes symptoms like hot flushes, palpitations , headaches, low mood, memory problems, fatigue, urinary symptoms and lower libido.

    The low hormone levels can have long-term effects too. The risk of heart attacks is five times higher after menopause than before. This is really important, especially as outcomes for women after a heart attack are worse than for men. The risk of stroke, dementia and osteoporosis and other conditions all rise as well.

    How does the menopause affect your blood pressure and heart health?

    How do you know when you are going through the menopause?

    Youre Taking Birth Control Pills

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    Birth control pills are a great way to manage your family planning, but some of them can also be responsible for giving you high blood pressure. Because many forms of the pill contain estrogen, and estrogen is known to increase blood pressure, you may end up with a case of hypertension.

    If this happens, talk to Dr. Jeereddy about replacing your pill with one that contains only progestin, or switching your birth control method to an IUD, an implant, or an injection.

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