From the Guidelines
Norethindrone can increase blood pressure in some individuals, particularly those with pre-existing hypertension, and its use should be carefully considered and monitored in these cases. This progestin-only contraceptive or hormone therapy medication may cause elevated blood pressure as a side effect, though it's less common than with combination hormonal contraceptives that contain estrogen. The risk is higher in people who already have hypertension, are overweight, smoke, or are over 35 years old. According to the 2020 International Society of Hypertension global hypertension practice guidelines 1, the effect of medications like norethindrone on blood pressure may highly vary between individuals.
Some key points to consider when evaluating the risk of norethindrone on blood pressure include:
- The potential for fluid retention and alterations in the renin-angiotensin-aldosterone system that regulates blood pressure
- The importance of monitoring blood pressure before and periodically during norethindrone treatment
- The need for alternative contraceptive or hormone therapy options for individuals with existing hypertension
- The potential for adjusting antihypertensive medications if norethindrone is necessary for treatment, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
It is essential to weigh the benefits and risks of norethindrone use in each individual, considering their unique medical history and risk factors, as emphasized by the 2013 ESH/ESC guidelines for the management of arterial hypertension 1. If you're taking norethindrone and notice symptoms like headaches, dizziness, or visual changes, you should have your blood pressure checked. Healthcare providers should carefully evaluate and manage the potential risks associated with norethindrone use, particularly in individuals with pre-existing hypertension or other cardiovascular risk factors.
From the Research
Norethidrone and Blood Pressure
- The effect of norethidrone on blood pressure is not directly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the impact of menopausal hormone therapy (HT) on blood pressure and cardiovascular disease risk.
- One study found that the combined formulations of conjugated equine estrogens plus progestogen increased systolic blood pressure (SBP) and the risk of hypertension 2.
- Another study suggested that transdermal estrogens have a lower risk of thrombosis compared with oral regimens, and that natural progesterone and dydrogesterone have a neutral effect on cardiovascular disease risk factors 3.
- The studies also highlight the importance of considering the type of estrogen, progestogen, and route of administration when evaluating the effects of HT on blood pressure and cardiovascular disease risk 4, 5, 6.
Key Findings
- The effect of HT on blood pressure is influenced by the formulation used, especially the type of estrogen 2.
- Transdermal estrogens may have a lower risk of thrombosis and cardiovascular disease compared with oral regimens 3, 6.
- The decision to use HT should be individualized, taking into account the patient's symptoms, preferences, and risk of cardiovascular disease 3, 4, 5.