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Hypertension in Women: Impact of Contraception, Fertility, and Hormone Treatment

  • Women and Heart Disease (E. Michos, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review will summarize the current literature assessing the relationship between hypertension and contraception, fertility, pregnancy, hormone replacement therapy, and transgender health.

Recent Findings

Hypertension is a highly prevalent condition among women, with variations in the prevalence of hypertension throughout a woman’s lifespan. During reproductive years, oral combined hormonal contraception is associated with an increased risk for developing hypertension and should be avoided in women with hypertension. Pregnancy in women with underlying hypertension increases risk for subsequent preterm birth, development of hypertensive disorders of pregnancy, and fetal growth restriction. As women age, the menopausal transition is associated with vasomotor symptoms for which hormone replacement therapy is used for severe symptoms. However, oral forms of hormone replacement are associated with cardiovascular risk, with little information known about its impact on hypertension. Additionally, gender affirming hormone therapy includes estrogen and progesterone and is integral to the health care of transgender women; however, its relationship with hypertension is not well established.

Summary

Contraception, pregnancy, and hormone replacement therapy all have different impacts on hypertension, with some shared and some varied mechanisms contributing changes in blood pressure control and future risk of cardiovascular disease. We describe here theoretical hormonal mechanisms, screening, and management of hypertension in women, focusing on the relationships between hypertension and contraception, fertility, pregnancy, hormone replacement therapy, and transgender health.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Gianna Wilkie & Laura Ferraro

  2. University of Massachusetts Chan Medical School, Worcester, MA, USA

    Ekaterina Skaritanov, Micaela Tobin & Angela Essa

  3. Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Anna Gubala

  4. Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Lara C. Kovell

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  1. Gianna Wilkie
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Wilkie, G., Skaritanov, E., Tobin, M. et al. Hypertension in Women: Impact of Contraception, Fertility, and Hormone Treatment. Curr Cardiovasc Risk Rep 16, 195–206 (2022). https://doi.org/10.1007/s12170-022-00705-y

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