High BP during pregnancy tied to worse menopausal symptoms

Women with hypertensive disorders during pregnancy tend to have more bothersome menopausal symptoms such as night sweats and hot flashes compared with women without such history, a study finds.

While it is established that both hypertensive disorders of pregnancy (HDP) and menopausal symptoms are independently associated with cardiovascular (CV) risk, whether there is an association between the two risk factors is not yet known.

“Improved understanding of the association between these unique female specific CV risk factors may help identify those at higher risk, and facilitate development of more accurate risk prediction models and implementation of targeted and individualized risk reduction strategies,” said the researchers.

In the cross-sectional study, 2,684 women aged 40–65 years who attended specialty consultation in women’s health clinics at Mayo Clinic were assessed on menopausal symptoms. Among these women, 180 had self-reported history of HDP. [Menopause 2020;doi:10.1097/GME.0000000000001638]

The primary outcome of menopause symptoms, as indicated by total scores on the Menopause Rating Scale (MRS), were significantly higher in women with a history of HDP compared with those without such history during pregnancy and those who were never pregnant (mean, 16.4 vs 14.4 and 14.7; p=0.002).      

Specific domains in the MRS, such as psychological symptoms (eg, depression, irritability, anxiety; p=0.021) and somatic symptoms (eg, hot flashes and sleep disturbance; p=0.001) were also more common in women with a history of HDP than those without or never pregnant.

However, after adjusting for multivariate confounders, only the association with total MRS scores and somatic symptom score remained significant among women who were receiving hormone therapy, while none of the associations were significant among women not on hormone therapy.

Additionally, urogenital symptom domain scores turned out to be significantly associated with history of HDP compared with those without among women on hormone therapy (p=0.039).

“Women with HDP may have been prompted to seek treatment with hormone therapy due to more severe symptoms compared to women without HDP,” explained the researchers.

“[The] study confirmed an association between menopause symptoms and a history of HDP, both reproductive factors unique to women and independently predictive of future CVD risk,” they concluded. “It is likely that HDP and vasomotor symptoms are both manifestations of underlying vascular dysfunction in women.”

According to the ACC/AHA* guideline for primary prevention of CVD, HDP such as preeclampsia presents a risk-enhancing factor for CVD and should prompt a risk discussion between doctors and patients.

“Despite identification of these CVD risk factors, prediction of which women will go on to develop symptomatic disease remains difficult, and a uniform approach to follow-up of women with a history of an HDP is lacking,” the researchers pointed out.

They also suggested more studies be done to guide development of more accurate prediction models for CV risk in women and risk reduction strategies.

“We know medical providers have historically done a lousy job identifying and following women with histories of HDP, despite knowing that they have a higher heart disease risk,” said lead author Dr Stephanie Faubion from Center for Women’s Health at Mayo Clinic in Rochester, Minnesota, US.

“This study is another reminder that these women are different. It is important that they not only receive education with regard to what they may experience during menopause, but also that they undergo routine screenings and counselling on how they can reduce their risk for heart disease,” she added.