Hormone replacement therapy may increase a woman’s risk of chronic reflux

By Denise Mann Health Day Reporter

MONDAY, July 3, 2023 (HealthDay News) — Some women take hormone replacement therapy (HRT) to combat the hot flashes and night sweats that accompany menopause, but a new study review suggests hormone therapy may increase the risk of heartburn.

Women who take or have taken hormones are at greater risk of developing gastroesophageal reflux disease, or GERD, which is characterized by heartburn, difficulty swallowing and chest pain, according to analysis of five previous studies. It was published on June 27 in Menopausejournal of the North American Menopause Society.

This is not the first time that HRT has been associated with side effects. Long-term use fell out of favor in 2002 after the Women’s Health Initiative study found that the hormones increased the risk of stroke and breast and ovarian cancer. Today, short-term use of hormone therapy is considered safe for some women who have severe symptoms of menopause.

“The main message is that the use of hormone therapy may be associated with GERD and women at risk should be counseled accordingly,” said Dr Stephanie Faubionmedical director of the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health in Rochester, Minn.

Women at risk include those who are obese, smokers, have moderate to high alcohol consumption and lack regular physical activity, she said. Vigorous physical activity after meals can also put a woman at risk.

Previous research has shown that the risk of GERD is higher during pregnancy when hormones increase and also when women take birth control pills.

Hormones can weaken the lower sphincter, or muscle, that connects the esophagus to the stomach, allowing acid easy access to the food pipe. Estrogen can also increase stomach acid production, according to Faubion.

For the new journal, a team led by Dr AS Wafa Aldhaleei from the Johns Hopkins Bloomberg School of Public Health in Baltimore, reviewed five studies involving more than one million women. None had been diagnosed with GERD at the start of the studies.

The analysis showed that women in the studies who took estrogen or a combination of estrogen and progesterone had a higher risk of developing GERD than those who did not.

Women who took a combined formulation of estrogen and progestins had a lower risk of GERD than women who took either of these hormones alone.

Women who still have a uterus should take progesterone with estrogen because taking estrogen alone increases the risk of cancer of the uterine lining (endometrium).

Faubion’s advice is the same for all women with GERD, whether or not they are on hormone replacement therapy.

“These recommendations include maintaining a healthy body weight, quitting smoking, reducing or eliminating alcohol consumption, avoiding larger and heavier meals. [especially near bedtime]caffeine avoidance, regular physical activity [but not vigorous activity right after a meal],” she says.

Dr Marguerite Rossignol is a Clinical Associate Professor of Obstetrics and Gynecology at NYU Grossman School of Medicine in New York City. She did not notice an increase in GERD symptoms in her patients on HRT.

“It’s an interesting study, but it’s based on five studies, and therefore I don’t think I would change my practice of prescribing hormone therapy,” said Nachtigall, who reviewed the results.

The majority of studies included in this review involved women taking oral hormones, she pointed out.

“It is possible that any oral medication is a stomach irritant and that could be one explanation. [for the increase in GERD]“, said Nachtigall, suggesting that future research investigates whether hormones delivered via skin patches or other pathways increase the risk of GERD.

If you develop GERD, see your doctor to find out what’s causing it, she advised.

“If it [becomes] knowing that oral hormone therapy caused GERD, then I might convert or consider switching to a [patch] route, and if there is no other source for GERD, it might be worth considering a trial without hormone therapy to see if that was the cause,” Nachtigall said.

Hormone therapy during and after menopause must be individualized, she said.

“I think it’s important for people to be assessed to see if hormone therapy would benefit them,” Nachtigall added.

The US National Institute of Diabetes and Digestive and Kidney Diseases has more information on stomach pains.

SOURCES: Stephanie Faubion, MD, medical director, North American Menopause Society, director, Mayo Clinic Center for Women’s Health, Rochester, Minnesota; Margaret Nachtigall, MD, clinical associate professor, department of obstetrics and gynecology, NYU Grossman School of Medicine, New York City; MenopauseJune 27, 2023

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