This week’s article from Menopause expert and awareness advocate, Nicola Ryan, will highlight the influence that the changing of oestrogen levels can have on a wide variety of our organs and how this can potentially impact on the management of coexistent medical conditions.
These conditions require careful evaluation by their healthcare professional when advising women about the risks and benefits associated with starting hormone therapy and most importantly the form that they receive their therapy, for example, through the skin, orally or vaginally and is there any interaction with their current medications.
Cardiovascular disease:
Did you know that cardiovascular disease is the most common cause of death in women in Europe and might I add that this is relatively very uncommon before menopause and as you transition into menopause cardiovascular events increase. Actually, menopause transition is considered an independent risk factor for heart disease, as highlighted by the British Menopause Society.
Hypertension (high blood pressure) is very common in women in their 50’s and up and the hormone shift is a known factor. I see ladies regularly in the pharmacy and they are on different types of blood pressure tables and still struggle to keep the levels low. It is important that women about to enter the menopause transition to get regular blood pressure checks. There is no evidence that oestradiol-based hormone therapy increases blood pressure, if anything hormone therapy can help reduce blood pressure. These therapies can be taken alongside antihypertensive medication, provided of course that the blood pressure remains within controlled levels. Transdermal oestrogen would be the preferred choice for women with any cardiovascular issues as the oestrogen is absorbed through the skin and avoids going through the liver where our clotting cascade exists. This also stands for people who are high risk of getting a VTE (venous thromboembolism or a clot). There is some consideration to be given to women who have a genetic predisposition to forming a clot. Factor V Leiden can further increase the risk of VTE in women receiving oral hormone therapy and so in my view this needs specialist care.
Diabetes mellitus is increasing as the population ages. When our oestrogen levels are low, biochemical changes occur in our bodies and this results in metabolic changes such as increased insulin resistance, abdominal fat persistence and the risk of becoming a type 2 diabetic. Studies have shown that hormone therapy can decrease the incidence of type 2 diabetes, as well as improving glycaemic control.
Migraines are more common in women than men after their periods occur. Migraines are very common in perimenopause years. In my experience, I see lots of women whose migraines worsen in their 40’s but they would have never associated this with perimenopause. They would be collecting anti migraine medication monthly. I often find myself as a pharmacist being the giver of the good news and explain that these migraines often worsen when our hormones start to shift. Some women will be very grateful with this knowledge, and understandably some will not be so grateful. It also not one size fits all here, some women’s migraines may ease up at this time and some may only start to experience migraines for the first time or since their younger years. Using hormone treatment may help to reduce these troublesome migraines but depending on several individual factors the treatment may have to be tailored to everyone.
Epilepsy and the use of hormone therapy, unfortunately the research is limited. Seizure frequency may increase in the perimenopause and this may be due to sleep deprivation or due to fluctuating hormones. Some data has suggested that hormone therapy can increase the seizure frequency in postmenopausal women. In my opinion, this is a very specialised area and these cohort of women need specialist care from both, neurologist, and menopause specialist.
Here is just a quick synopsis of some comorbidities and the menopause. There are many more examples but this gives an idea on how menopause can impact many of us in very different ways. If you have any comorbidities and are thinking of starting hormone therapy, please discuss your options with your healthcare professional.
