Hypertension during pregnancy associated with more severe menopause symptoms
Women with a history of hypertensive disorders of pregnancy, such as gestational hypertension and preeclampsia, are also likely to have bothersome menopause symptoms, according to study data published in Menopause.
“There are some female-specific factors that are associated with increased risk for future heart disease, and these include vasomotor symptoms — hot flashes/night sweats — and high blood pressure during pregnancy,” Stephanie S. Faubion, MD, MBA, director of Mayo Clinic Center for Women’s Health, in Jacksonville, Florida, and medical director of The North American Menopause Society, told Healio. “We found that these two risk factors for future heart disease — hypertensive pregnancy disorder and severe menopause symptoms — are linked.”
Faubion and colleagues conducted a cross-sectional study analyzing questionnaire data and medical records from perimenopausal and postmenopausal women aged 40 to 65 years. All participants had a specialty menopause or sexual health consultation at two Mayo Clinic women’s health clinic locations between May 2015 and September 2019 (n = 2,684).
Participants self-reported menopause symptoms with the Menopause Rating Scale questionnaire. Higher scores on each question signified more severe symptoms, and total scores were stratified into four categories: no or minimal, mild, moderate or severe symptoms. Symptoms were also categorized into three areas: somatic, psychological and urogenital. Additional questionnaires were used to assess each participant’s depressive symptoms and relationship distress.
At the time of the clinical visit, participants self-reported history of hypertensive disorders, gestational diabetes, reproductive stage and use of menopausal hormone therapy. Demographic information was obtained through medical records.
Participants were divided into three groups: those with no pregnancy (n = 402), those who had pregnancy and no reported history of hypertensive disorders (n = 2,102) and those who had a history of hypertensive disorders of pregnancy (n = 180).
Besides being more likely to have a history of gestational diabetes, hyperlipidemia, heart disease, stroke, migraine and hypertension, women who had a history of hypertensive disorders during pregnancy had a higher mean Menopause Rating Scale total than those with no pregnancy or pregnancy with no hypertensive disorder (P = .002). Women with hypertensive disorders also had higher mean Menopause Rating Scale scores in the domains of psychological symptoms (P = .021) and somatic symptoms (P = .001).
For women who were HT users, those with hypertensive disorders of pregnancy had higher mean Menopause Rating Scale total scores than those with no hypertensive disorder or no pregnancy (P = .003). In a multivariable model stratified for use of HT, participants with a history of hypertensive disorders of pregnancy scored, on average, 2.28 points higher on the Menopause Rating Scale than women with pregnancy and no hypertensive disorder (95% CI, 0.12-4.44; P = .039).
“Two things are key: Women with [hypertension during pregnancy or menopausal vasomotor symptoms] or both should make sure to assess their cardiovascular risk and can take steps to reduce risk [through] lifestyle changes, such as weight loss, healthy diet, stop smoking, reduce stress, and also knowing their numbers — cholesterol, blood pressure, glucose, BMI — and addressing, if needed,” Faubion said. “The other key thing is that women with a history of a hypertensive pregnancy might have worse symptoms in menopause and should be proactively counseled on management options.”
Faubion added that the findings could spur the development of better cardiovascular risk prediction models for women and encourage emphasis of risk modification for those at-risk.
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Stephanie S. Faubion, MD, MBA, can be reached at email@example.com.