Does the Menstrual Cycle Cause Hypertension?
The natural menstrual cycle itself does not cause sustained hypertension, but arterial distensibility and blood pressure do fluctuate modestly throughout the cycle in relation to hormonal changes, with blood pressure typically being slightly higher at menstruation onset and lower during the mid-luteal phase. 1, 2
Blood Pressure Variations During the Normal Menstrual Cycle
The evidence demonstrates that blood pressure undergoes subtle physiological fluctuations during the menstrual cycle in both normotensive and hypertensive women:
Blood pressure is highest at the onset of menstruation (systolic P < 0.05; diastolic P < 0.001), then decreases during the follicular phase and reaches its lowest point during days 17-26 of the cycle (mid-luteal phase), with adjusted diastolic blood pressure differences of approximately 1.2 mmHg between phases. 2
Arterial distensibility fluctuates during the menstrual cycle in relation to changes in estrogen concentration, which may explain these modest blood pressure variations. 1
In normotensive women, these changes are physiological and do not result in clinically significant hypertension. 2, 3
Hypertensive Women and the Menstrual Cycle
The pattern differs somewhat in women with pre-existing hypertension:
Hypertensive women may experience blood pressure increases during ovulation (P < 0.01), particularly those with relatively low plasma renin activity (< 2 ng/mL/h), with the increase primarily occurring at night. 4
Hypertensive women demonstrate increased testosterone during ovulation and increased testosterone and plasma renin activity during the luteal phase compared to normotensives. 4
In rare cases, severe menses-associated (catamenial) hypertension can occur, requiring specialized treatment with gonadotropin-releasing hormone agonists. 5
Menstrual Disorders and Hypertension Risk
Women with menstrual disorders (heavy, painful, or irregular menstruations, or premenstrual syndrome) have a higher risk of developing sustained hypertension, distinguishing this from normal cyclical variations. 1
- Both early and late menarche have been associated with hypertension and other cardiometabolic risk factors leading to greater cardiovascular disease risk. 1
Clinical Implications
The modest blood pressure fluctuations during the normal menstrual cycle (typically 1-2 mmHg) are not clinically significant and do not constitute hypertension. 2, 3 However, clinicians should be aware that:
Blood pressure measurements may vary by 1-2 mmHg depending on the phase of the menstrual cycle when measured. 2
Women with pre-existing hypertension may experience more pronounced cyclical variations, particularly during ovulation. 4
Abnormal menstrual patterns (not normal cyclical variations) are independent risk factors for developing sustained hypertension. 1
This is distinct from oral contraceptive-induced hypertension, which causes sustained blood pressure elevation (2.3/1.6 mmHg higher on average) and doubles the adjusted relative risk for hypertension in current users, even with low-dose preparations. 1