Menopause Live - IMS Updates

Date of release: 26 October, 2009

The effect of HRT on intra-ocular pressure

Current research on the diversity of hormone replacement therapy (HRT)-related effects does not necessarily focus on traditional issues, such as quality of life, cardiovascular disease, bone protection or cancer. Some studies highlight the effects of HRT on other organs and systems that are rarely addressed in the context of menopause medicine. Tint and colleagues [1] have investigated intra-ocular pressure (IOP) in young postmenopausal women who had no ophthalmic problems. Ninety-one ever-users of HRT (mean age 56 years) were compared with 172 never-users of postmenopausal hormones (mean age 61 years). The study showed that hormone users had a mean 1.4 mmHg lower IOP than that found in the non-users. Adjustment for age, time of measurement and concomitant therapy with beta-blockers did not change the results. There was no difference between women taking estrogen alone or a combination of estrogen and progestogen.


Elevated IOP may have a major impact on health and quality of life, since glaucoma may lead to blindness. Glaucoma is another age-related disease and the number of people with open-angle glaucoma is increasing each decade. The prevalence of glaucoma may vary to a large extent in different countries and continents, the current figure in the Western world being around 2–4% [2]. While Tint and colleagues [1] showed no difference in IOP comparing estrogen to estrogen + progestogen use, a very small study from Turkey found that estrogen reduced IOP but estrogen + progestogen or tibolone did not [3]. Lens opacity was not affected after 12 months of therapy. The Nurses’ Health Study investigated a possible association between open-angle glaucoma and HRT in women with healthy eyes at baseline [4]. Women older than 65 years at the end of follow-up who had entered menopause after age 54 years had a 47% reduced risk for glaucoma when compared to women entering menopause at age 50–54 years. This may point at the protective effect of endogenous sex hormone production. Furthermore, current use of estrogen + progestogen, but not estrogen alone, was associated with a 42% reduced risk for glaucoma in comparison to never-users of hormones. Another relevant issue that was discussed in the literature relates to lens opacities and cataracts. While cataracts become more prevalent as we age, there is also a higher incidence in women, pointing at a possible involvement of steroidal sex hormones in their pathogenesis. However, data on HRT and cataracts seem contradictory. While one study found no association between HRT and any type of cataract [5], another study claimed that HRT was associated with a lower prevalence of posterior subcapsular opacity [6]. Menopause physicians should be aware of the diversity of effects of postmenopausal hormone therapy on various bodily systems that are not in the main focus of clinical attention. Look for more about this in one of the upcoming issues of Menopause Live.


Amos Pines
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel


  1. Tint NL, Alexander P, Tint KM, et al. Hormone therapy and intraocular pressure in nonglaucomatous eyes. Menopause 2009 Sep 16. Epub ahead of print.

  2. Quigley HA, Braman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262-7.

  3. Uncu G, Avci R, Uncu Y, et al. The effects of different hormone replacement therapy regimens on tear function, intraocular pressure and lens opacity. Gynecol Endocrinol 2006;22:501.

  4. Pasquale LR, Rosner BA, Hankinson SE, et al. Attributes of female reproductive aging and their relation to primary open-angle glaucoma: a prospective study. J Glaucoma 2007; 16:598-605.

  5. Defay R, Pinchinat S, Lumbroso S, et al. Relationships between hormonal status and cataract in French postmenopausal women: the POLA study. Ann Epidemiol 2003;13:638-44.

  6. Freeman EE, Munoz B, Schein OD, et al. Hormone replacement therapy and lens opacities: the Salisbury Eye Evaluation project. Arch Ophthalmol 2001;119:1687-92.