The association of elevated levels of estrogen and progesterone with increased gastroesophageal reflux (GERD) has been reported in a number of studies. Observations supporting this association include decreases found in lower esophageal sphincter (LES) pressures during pregnancy and with the use of sequential oral contraceptives, and data showing that postmenopausal hormone (PMH) therapy may increase the risk of GERD symptoms in overweight and obese women. This prospective cohort study evaluated the risk of GERD among postmenopausal women using PMH therapy, selective estrogen receptor modulators (SERMs), or over-the-counter (OTC) hormone preparations. The study subjects were female nurses with GERD symptoms among a cohort of 51,637 postmenopausal women enrolled in the Nurse's Health Study who provided information biennially on use of PMH therapy since 1976 and on GERD symptoms, current use of SERMS or OTC hormone preparations since 2002.
Of the 51,637 women in the total cohort, 12,018 women (23%) reported GERD symptoms. Multivariate logistic regression analysis showed that compared with women who never used PMH, the odds ratio (OR) for the risk of GERD symptoms was 1.46 (95% confidence interval [CI], 1.36-1.56) for past users of PMH, 1.66 (95% CI, 1.54-1.79) for current users of estrogens only, and 1.41 (95% CI, 1.29-1.54) for current users of combined estrogen and progesterone. The associations persisted after controlling for potential confounders: age-adjusted, age- and body mass index adjusted, and multivariate models. The risk of GERD symptoms associated with PMH use was significantly greater with both increasing dosage and duration of estrogen use (P value for trends <.001). Compared with women who never used PMH or SERMs, women currently using a SERM had an OR for GERD symptoms of 1.39 with a 95% CI of 1.22-1.59. Women currently using OTC hormone preparations had an OR for GERD symptoms of 1.37 with a 95% CI of 1.16-1.62) compared with nonusers.
These findings show that postmenopausal use of estrogens, SERMs, or OTC hormone preparations is associated with increased risk of GERD symptoms.