The Association of Estrogen Replacement Therapy and the Raynaud Phenomenon in Postmenopausal Women

doi:10.1059/0003-4819-129-3-199808010-00009

The Association of Estrogen Replacement Therapy and the Raynaud Phenomenon in Postmenopausal Women

From the Boston University Arthritis Center and Boston University Medical Center, Boston, Massachusetts; and the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Acknowledgments: The authors thank J. Coffman, MD, and J. Korn, MD, for their insight and advice; Bryan Besso for interviewing participants; and the staff and participants of the Framingham Offspring Study. Grant Support: In part by National Institutes of Health grants AR20613 and AG09300, National Institutes of Health National Heart, Lung, and Blood Institute contract N01-HC-38038, and a Canadian Arthritis Society Research Fellowship (Dr. Fraenkel). Requests for Reprints: Liana Fraenkel, MD, Boston University Arthritis Center, A203, 715 Albany Street, Boston, MA 02118. Current Author Addresses: Drs. Fraenkel, Zhang, and Felson, Ms. Chaisson, and Mr. Evans: Boston University Arthritis Center, A203, 715 Albany Street, Boston, MA 02118.

Abstract

Background: Hormonal factors may play an important role in the pathophysiology of the Raynaud phenomenon. Experimental studies have shown an increased vasoconstrictor response to estrogen, a response that can be prevented by the addition of progesterone.

Objective: To measure the association between estrogen replacement therapy (alone and with progesterone) and the Raynaud phenomenon.

Design: Cross-sectional study.

Setting: Framingham Offspring Study.

Participants: 497 postmenopausal women.

Measurements: Prevalence of the Raynaud phenomenon according to hormone use. Covariates measured included age, body mass index, smoking, alcohol consumption, and β-blocker use.

Results: Forty-nine women were classified as having the Raynaud phenomenon (9.9%). The prevalence of this phenomenon was 8.4% among women who did not receive estrogen, 19.1% among women receiving estrogen alone, and 9.8% among women receiving estrogen plus progesterone. The adjusted odds ratio for the Raynaud phenomenon was 2.5 (95% CI, 1.2 to 5.3) for unopposed estrogen and 0.9 (CI, 0.3 to 2.6) for estrogen plus progesterone, with nonusers as the reference group.

Conclusions: Unopposed estrogen therapy was associated with the Raynaud phenomenon in postmenopausal women. This association was not present in women who were receiving combined hormone therapy.