Incidence of endometrial spotting or bleeding during continuous-combined estrogen-progestin therapy in postmenopausal women with and without hypertension.

Abstract

OBJECTIVE:

Endometrial spotting or bleeding is a common adverse effect among women taking continuous-combined estrogen-progestin therapy. The renin-angiotensin-aldosterone system plays a major role in hypertension and is present in the endometrium. We hypothesized that postmenopausal women with hypertension would have a higher incidence of bleeding compared with postmenopausal women without hypertension.

METHODS:

A multivariate mixed-effects logistic model estimated the odds ratios for the relationship of hypertension status or use of antihypertensive drugs with endometrial bleeding using the Women's Health Initiative database.

RESULTS:

The incidence of spotting or bleeding in the first 12 months of estrogen-progestin use was 42% in women aged 50 to 79 years. Women with hypertension were more likely to experience bleeding than women without hypertension (odds ratio, 1.07; 95% CI, 1.02-1.13). Overall antihypertensive medication use increased bleeding with an odds ratio of 1.24, whereas angiotensin II receptor antagonists had a reduced odds ratio (0.53).

CONCLUSIONS:

Postmenopausal women with hypertension are more likely to bleed than postmenopausal women without hypertension when taking continuous estrogen-progestin, with less bleeding in women using angiotensin II receptor antagonists. This finding is novel and supports our hypothesis that the endometrial renin-angiotensin-aldosterone system may contribute to endometrial bleeding.

• Authors: Intira Sriprasert, Hind Beydoun, Vanessa Barnabei, Rami Nassir, Andrea Z LaCroix, David F Archer
• Journal: Menopause (New York, N.Y.) (Menopause) Vol. 22 Issue 10 Pg. 1067-75 (Oct 2015) ISSN: 1530-0374 [Electronic] United States
• PMID: 25756697 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Estrogens
• Progestins

Topics

• Aged
• Endometrium (drug effects)
• Estrogen Replacement Therapy (adverse effects, methods)
• Estrogens (administration & dosage, adverse effects)
• Female
• Humans
• Hypertension (complications)
• Middle Aged
• Postmenopause (physiology)
• Progestins (administration & dosage, adverse effects)
• Risk Factors
• Uterine Hemorrhage (chemically induced, etiology, prevention & control)