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High Blood Pressure in Women

By Rosanna Sutherby, PharmD

June 09, 2020

Ask A Pharmacist

Nearly half of all adults in the United States have hypertension (high blood pressure), and 43% are women. The American College of Cardiology (ACC) and the American Heart Association (AHA) define hypertension as blood pressure that is 130/80 mm Hg or above. High blood pressure is a significant risk factor for heart disease, killing more women than any other illness.

Different stages in life can bring about various changes in blood pressure for women. Understanding how your body works can help you control your blood pressure and prevent hypertension as you move through life’s different phases.

Does Your Menstrual Cycle Affect Your Blood Pressure?

Some studies show that premenstrual syndrome (PMS) may affect your blood pressure. A 1991 study found that a woman’s blood pressure fluctuates based on different stages of her menstrual cycle. The study found that blood pressure tended to be highest at the start of the menstrual cycle and lowest between days 17 and 26.

A more recent study found that young adult women who experienced PMS had higher diastolic blood pressure than those without PMS. Further studies are needed to determine if PMS is a risk factor for developing hypertension later in life.

How Do Birth Control Pills Affect Your Blood Pressure?

We now know that oral contraceptives, or birth control pills, that contain estrogen can increase blood pressure in some women. High blood pressure can develop as early as six months or as late as six years after you start taking oral contraceptives. You are more likely to have high blood pressure while taking birth control pills if:

You are overweight.
You have a history of high blood pressure during previous pregnancies.
You have a family history of kidney disease or high blood pressure.

Even if you do not have the risk factors listed above, you must talk to a healthcare provider before taking birth control pills. Your doctor will need to conduct a thorough physical exam and take a detailed medical history. He or she will also assess your blood pressure before starting birth control pills and regularly after that.

If you develop hypertension while taking birth control pills, you will need to stop taking them. Your blood pressure will likely return to normal after discontinuing the oral contraceptives. The following are safe alternatives for contraception if you have high blood pressure:

progestin-only pills (norethindrone, Camila, Ortho Micronor, and others)
Mirena (levonorgestrel) intrauterine device (IUD)
Paragard copper IUD
Nexplanon (etonogestrel) implant
Depo-Provera (medroxyprogesterone acetate) injection (do not use if your blood pressure is over 160/100 mmHg)
over-the-counter products, such as condoms, spermicide, and female condoms

Be sure to keep your appointments with your healthcare provider regardless of what type of contraceptive you are using. You should have your blood pressure checked regularly, especially if you are using an estrogen-containing contraceptive.

High Blood Pressure During Pregnancy

In some cases, high blood pressure may develop during pregnancy. High blood pressure that occurs after 20 weeks of pregnancy is called gestational hypertension. When accompanied by high protein levels in the urine, it is considered preeclampsia.

You are more likely to have preeclampsia if:

You or a family member has had preeclampsia during previous pregnancies.
You have a history of high blood pressure.
This is your first pregnancy.
You are very young or older than 35 during your pregnancy.
You are obese.
You are carrying multiple babies.
You have diabetes.
You have kidney disease.

Untreated high blood pressure during pregnancy is dangerous for both you and your baby, and preeclampsia can be fatal for you and your baby as well. Because hypertension can often develop slowly without symptoms, you must regularly check your blood pressure during pregnancy.

Immediately let your doctor know if you experience any of the following signs and symptoms of preeclampsia:

blood pressure above 140/90 mmHg
severe headaches
blurred vision, temporary loss of vision, or sensitivity to light
upper abdominal pain
nausea
vomiting
shortness of breath
swelling of the face and hands

It is important to be as healthy as possible going into your pregnancy. Try to maintain a healthy weight, and keep your blood sugar under control if you have diabetes. If you smoke, quit smoking, and always continue exercising.

Complications of preeclampsia include slow growth of the baby, low birth weight, premature delivery, and damage to your kidneys, liver, eyes, and other organs. However, if your preeclampsia is detected early, your doctor can work with you to help prevent complications.

Related article: Allergy Medicines and Hypertension

Menopause and Hypertension

After menopause, women’s estrogen levels decrease, and this drop in natural estrogen can increase blood pressure. Nitric oxide in your body helps to dilate blood vessels and facilitate blood flow. Studies show that estrogen promotes the production of nitric oxide. As estrogen levels drop after menopause, you have less nitric oxide, and your blood vessels become stiffer. This increases the pressure in the blood vessels as the blood passes through them.

Nitric oxide also plays a role in regulating your salt sensitivity. As your estrogen levels and circulating nitric oxide drop, you may become more sensitive to sodium. This means that consuming the same amount of salt that you did when you were premenopausal may increase your blood pressure.

Maintaining healthy blood pressure is possible after menopause. Avoiding high-sodium foods, exercising regularly, quitting smoking, and getting regular doctor checkups are ways you can manage your blood pressure after menopause.

Regardless of your stage in life, maintaining a healthy lifestyle and having regular checkups with your healthcare provider is essential to keeping your blood pressure under control. If you take medications to lower your blood pressure, you can use a free Rx savings card to get the lowest prescription price at a pharmacy near you.

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Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.cdc.gov/bloodpressure/facts.htm

https://www.wellrx.com/health-conditions/about/health-condition/hypertension/~default/

https://www.wellrx.com/health-conditions/about/health-condition/cardiovascular-disease-overview/~default/

https://pubmed.ncbi.nlm.nih.gov/1657498/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116659/

https://pubmed.ncbi.nlm.nih.gov/12263383/

https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

https://www.wellrx.com/norethindrone/drug-information/

https://www.wellrx.com/mirena/drug-information/

https://www.wellrx.com/nexplanon/monographs/

https://www.wellrx.com/depo-provera/drug-information/