Women who have used hormone therapy for menopausal symptoms may be more likely to develop gastro-oesophageal reflux disease, new analysis suggests.

Researchers have explored a potential connection between hormone therapy (HT) for managing menopausal symptoms and the development of GERD.

In this blog, we’ll delve into the findings of this study and what they mean for postmenopausal women.

The research

In a recent analysis published online in June 2023, in Menopause –  the journal of The North American Menopause Society (NAMS) – researchers examined data from five previous studies involving over one million women who had not been diagnosed with gastroesophageal reflux disease prior to the studies.

Their objective was to explore a potential connection between hormone therapy for managing menopausal symptoms and the development of GERD.

The analysis yielded significant insights into the relationship between hormone therapy and GERD:

  • Increased risk: Women who were either current users or had used hormone therapy for menopausal symptom relief were 29 per cent more likely, overall, to develop GERD.
  • Oestrogen-only therapy: Those using oestrogen-only hormone therapy had a 41 per cent higher likelihood of developing GERD.
  • Progesterone-only therapy: Progesterone-only hormone therapy was associated with a 39 per cent higher risk of GERD.
  • Combination therapy: Interestingly, hormone therapy combining both oestrogen and progesterone was linked to only a 16 per cent higher risk of GERD.

To understand this link, let’s consider the effects of oestrogen and progesterone:

  • Oestrogen is known to increase stomach acid production and is associated with higher levels of plasma nitric oxide, a neurotransmitter that relaxes the lower oesophageal sphincter (LES). This relaxation can allow stomach acid to flow back into the oesophagus, leading to GERD symptoms.
  • Progesterone: Progesterone relaxes oesophageal muscles and the LES, further facilitating the reflux of stomach acid into the oesophagus, which can contribute to GERD symptoms.
Implications and further research:

The recent analysis suggests a noteworthy association between hormone therapy for menopausal symptom relief and the development of gastroesophageal reflux disease.

While this analysis provides valuable insights, it’s important to note that further research is recommended due to the limited number of included studies.

“Although additional research is needed, this study highlights the potential for the development of GERD symptoms with HT use,” says Dr Stephanie Faubion, NAMS medical director. “A review of risk factors for GERD and implementation of lifestyle strategies for prevention, such as smoking cessation, maintaining a healthy weight, and not lying down after a heavy meal, may be helpful to avoid GERD symptoms in menopausal women considering HT use.”

Review results are published in the article The Association Between Menopausal Hormone Therapy and Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis.

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