The majority of women worldwide struggle with menopausal symptoms, which can include hot flashes and/or night sweats (vasomotor symptoms), mood changes (anxiety, depression), vaginal dryness (genitourinary symptoms), irregular and/or heavy menstruation, weight gain, thyroid disorders (metabolic symptoms), anemia (low iron stores), fatigue and hair loss, joint pain (musculoskeletal symptoms), irritable bowel (gastrointestinal symptoms), dry skin, dry eyes, insomnia and others [1]. Unfortunately, only a quarter of women in the USA actually seek treatment options to manage their symptoms, which indicates that the conversion about how to get qualified menopause care should be amplified in every family household and workplace setting.

The Menopause Society (formerly known as the North American Menopause Foundation) and also the Canadian Menopause Society have advocated that a first line of treatment for relief of menopausal symptoms and complications is Hormone Therapy, or HT [2]. HT can be administered as either estrogen-progesterone combination therapy, progesterone-only therapy, or estrogen-only therapy.

Recently, a large population health clinical study was conducted in Alberta, Canada involving more than 112,000 women aged 45 years or older to examine the safety of the various formats and routes of administration for estrogen-only hormone therapies, which included oral pills, transdermal patches, and vaginal creams [3]. The clinical study enrolled women who had used at least two consecutive treatments of estrogen-only HT during the period of 2008 to 2019, and the primary outcome of the study was to evaluate the risk of developing high blood pressure (incident hypertension) [3]. The effect of the source of estrogen being taken – where the majority of study participants were taking either conjugated equine estrogen (CEE; 40%) or synthetic estradiol (55%), and a minority of participants were taking synthetic estrone (5%) –  was also investigated.

The key findings learned from the study:

• Women taking oral estrogen had a 14% higher likelihood of developing hypertension than those using transdermal estrogen.

• Women taking oral estrogen had a 19% elevated risk of developing hypertension compared to women using vaginal estrogen creams. This association was more notable in women below the age of 70 years.

• No differences in the risk of hypertension were observed for the study participants taking either transdermal or vaginal estrogen across all age groups.

• When comparing the two different sources of estrogen, conjugated equine estrogen was linked to an 8% heightened risk of high blood pressure.

• Higher daily estrogen dose in oral form, compared with the same dose in transdermal and vaginal forms, was associated with a significantly greater risk of hypertension.

• Long-term administration of any form of estrogen-only HT may increase the risk of developing hypertension.

To reduce the risk of developing hypertension while managing menopausal symptoms, a physician may prefer to prescribe estrogen HT treatment delivered as a transdermal patch or vaginal cream rather than the oral pill. The study also emphasized that HT treatment is  prescribed by a physician based on the specific needs and health profiles of each individual. Most women who are already taking oral estrogen – and are at low risk of developing hypertension – can continue their estrogen-only HT safely based on the recommendations and health monitoring by their physician.