Can Stopping Estrogen Cause High Blood Pressure?
No, stopping systemic estrogen therapy does not typically cause hypertension—in fact, discontinuing estrogen may actually increase hypertension risk in some women, though the evidence suggests this is more likely related to the loss of estrogen's modest protective cardiovascular effects rather than a direct causative mechanism.
Evidence on Estrogen Discontinuation and Blood Pressure
The available data on stopping estrogen therapy shows mixed but concerning findings:
One retrospective study found that 27.4% of women who discontinued hormone therapy were on antihypertensive medication compared to only 16.6% of women who continued therapy (P < 0.04), suggesting that stopping estrogen may predispose some women to hypertension risk 1.
However, this association likely reflects the loss of estrogen's modest beneficial effects rather than a withdrawal-induced hypertensive crisis 1.
The FDA drug label explicitly states that "for most women, elevated blood pressure will return to normal after stopping oral contraceptives," indicating that discontinuation of estrogen-containing products typically lowers rather than raises blood pressure 2.
Understanding Estrogen's Effects on Blood Pressure
The relationship between estrogen and blood pressure is complex and depends heavily on the route of administration:
While Taking Estrogen
The Women's Health Initiative found only a 1 mmHg increase in systolic blood pressure over 5.6 years with combined estrogen-progestin therapy—a clinically insignificant effect for most women 3.
Oral estrogen is associated with higher hypertension risk compared to transdermal (HR 1.14) or vaginal (HR 1.19) formulations 4.
In transgender women receiving estrogen therapy, studies show either no significant association with hypertension or even decreased systolic blood pressure when combined with antiandrogens 5, 6.
After Stopping Estrogen
Blood pressure typically returns to baseline or may slightly increase due to loss of estrogen's protective vascular effects 1, 7.
Estrogen withdrawal does not cause acute hypertensive episodes but may unmask underlying cardiovascular risk factors 7.
Clinical Management Approach
If Hypertension Develops After Stopping Estrogen
Treat the hypertension with standard antihypertensive medications, not by restarting estrogen 3.
The American Heart Association explicitly recommends that estrogen-progestin therapy should NOT be initiated to prevent cardiovascular disease (Class III, Level A), as it increases coronary heart disease events by 29%, stroke risk by 41%, and venous thromboembolism risk 2-fold 3.
Monitor blood pressure closely for 3-6 months after estrogen discontinuation to identify any changes requiring intervention 3, 1.
Important Caveats
Women who discontinue estrogen therapy may experience reduced quality of life, particularly in occupational satisfaction, which was significantly lower in women who stopped compared to those who continued (P < 0.02) 1.
The psychological consequences of stopping estrogen may be significant, and this should be weighed against cardiovascular risks when making discontinuation decisions 5.
Over 40% of postmenopausal women develop hypertension independent of hormone therapy, so any blood pressure elevation after stopping estrogen may simply reflect natural aging and menopausal changes rather than withdrawal effects 3.
Key Takeaway
Stopping estrogen does not directly cause hypertension as a withdrawal effect. If blood pressure rises after discontinuation, this likely represents either the loss of estrogen's modest protective effects or the natural progression of age-related hypertension 1, 7. Any hypertension that develops should be treated with standard antihypertensive medications rather than by restarting estrogen therapy 3.