title: Incidence of endometrial spotting or bleeding during continuous-combined estrogen-progestin therapy in postmenopausal women with and without hypertension.
abstract: OBJECTIVE
  Endometrial spotting or bleeding is a common adverse effect among women taking continuous-combined estrogen-progestin therapy. The renin-angiotensin-aldosterone system plays a major role in hypertension and is present in the endometrium. We hypothesized that postmenopausal women with hypertension would have a higher incidence of bleeding compared with postmenopausal women without hypertension.
  
  
  METHODS
  A multivariate mixed-effects logistic model estimated the odds ratios for the relationship of hypertension status or use of antihypertensive drugs with endometrial bleeding using the Women's Health Initiative database.
  
  
  RESULTS
  The incidence of spotting or bleeding in the first 12 months of estrogen-progestin use was 42% in women aged 50 to 79 years. Women with hypertension were more likely to experience bleeding than women without hypertension (odds ratio, 1.07; 95% CI, 1.02-1.13). Overall antihypertensive medication use increased bleeding with an odds ratio of 1.24, whereas angiotensin II receptor antagonists had a reduced odds ratio (0.53).
  
  
  CONCLUSIONS
  Postmenopausal women with hypertension are more likely to bleed than postmenopausal women without hypertension when taking continuous estrogen-progestin, with less bleeding in women using angiotensin II receptor antagonists. This finding is novel and supports our hypothesis that the endometrial renin-angiotensin-aldosterone system may contribute to endometrial bleeding.
authors.affiliation: 1Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 2Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 3Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA 4Department of Obstetrics and Gynecology, School of Medicine and Biomedical Sciences, University at Buffalo, New York, NY 5Department of Biochemistry and Molecular Medicine, University of California, Davis, CA 6Division of Epidemiology, Department of Family and Community Medicine, University of California San Diego School of Medicine, San Diego, CA.
authors.forename: Intira
authors.initials: I
authors.lastname: Sriprasert
authors.forename: Hind
authors.initials: H
authors.lastname: Beydoun
authors.forename: Vanessa
authors.initials: V
authors.lastname: Barnabei
authors.forename: Rami
authors.initials: R
authors.lastname: Nassir
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: David F
authors.initials: DF
authors.lastname: Archer
mesh_terms: D000368:Aged; D004717:Endometrium / Q000187:drug effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000379:methods; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology; D011372:Progestins / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000209:etiology* / Q000517:prevention & control
chemical_list: D004967:Estrogens; D011372:Progestins