Joint Influence of Age at Menopause and Hormone Therapy on Postmenopausal Hypertension Risk: NHANES 2011–2020

To improve shared decision-making about the potential risks and benefits of hormone therapy (HT), it is crucial to understand the joint effects of menopausal age and HT use on hypertension onset. This study examines the combined and individual effects of age at menopause and HT on hypertension onset in U.S. women based on their hysterectomy and oophorectomy history. This population-based, cross-sectional study included 4776 postmenopausal women with and without hysterectomy and oophorectomy history from the 2011–2020 National Health and Nutrition Examination Survey (NHANES). Age at hypertension onset was defined as the time scale at which a respondent was diagnosed with hypertension following the menopause onset. The weighted prevalence of hypertension was 40.0% (95% CI 38.2–41.8%) overall, highest in those who had an oophorectomy with or without hysterectomy (51.6%), followed by those with hysterectomy alone (45.3%), then in those with an intact uterus and ovaries (33.7%), p < 0.0001. Among women with an intact uterus and ovaries, those who experienced menopause before age 45 and used HT had a comparable risk of hypertension (aHR = 1.34, 95% CI: 0.81–2.22) to women who experienced menopause between ages 45 and 54 and did not use HT. Conversely, women who experienced menopause before age 45 and did not use HT showed a significantly increased risk of hypertension (aHR = 1.68, 95% CI: 1.27–2.22). The findings suggest that the absence of ovaries, with or without a uterus, HT use, and age at menopause are associated with the likelihood of hypertension development. This study highlights the need for personalized management and decision-making to reduce the risk of hypertension and cardiovascular disease in peri- and postmenopausal women.