Reproductive Factors May Influence Glaucoma, Elevated Intraocular Pressure Risk

Hormone Replacement Therapy Pills
A blister pack of HRT pills to treat side effects of menopause in which several doses have been missed.
Women who underwent menopause earlier had a higher risk of open-angle glaucoma compared with those who underwent menopause later.

The use of postmenopausal hormone (PMH) may be associated with a reduced risk of elevated intraocular pressure (IOP) or open-angle glaucoma (OAG), according to research published in Ophthalmology Glaucoma.

Researchers conducted a systematic review to determine the association between reproductive factors and glaucoma to better understand disease pathogenesis and improve prediction and treatment. They included 27 cohort, case-control, cross-sectional, or randomized-controlled trial design studies that measured IOP or confirmed OAG and analyzed at least 1 of the following: age at menarche, parity, gravidity, oral contraceptive (OC) use, age at menopause, duration of reproductive years, or postmenopausal hormone (PMH) use.

The team determined that a longer duration of OC use was associated with an increased risk of primary open angle glaucoma (POAG) (P =.04). Use of OCs for more than 5 years was linked with a 25% higher POAG risk (RR=1.25, 95% CI, 1.02-1.53).

Overall, the team noted that  PMH use may be associated with lower IOP.  They also found that estrogen-only PMH use may be associated with reduced OAG risk, which may be modified according to race, the report states.

Estrogen-only PMH use was linked with a 0.4% decreased risk of POAG each month (HR=0.996) in 1 study. Another analysis indicated the risk of incident OAG was lower among women who are Black who used estrogen-only PMH compared with placebos (HR=0.49; P =.01). 

Investigators observed a link between age at menopause and glaucoma risk. Women undergoing earlier menopause had a higher OAG risk compared with those who underwent menopause later (OR=3.4; 95% CI, 1.2-9.8). Women who underwent menopause before age 53 years (natural menopause only, surgical cases excluded) were more likely to have more than double the risk of OAG. 

Study limitations include an overrepresentation of individuals of White ethnicity, the potential for recall bias, and failure to perform IOP profiling for at-risk populations for glaucoma in some of the studies. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Madjedi KM, Stuart KV, Chua SYL, et al. The association of female reproductive factors with glaucoma and related traits: a systematic review. Ophthalmol Glaucoma. Published online June 9, 2022. doi: 10.1016/j.ogla.2022.06.003