TOPLINE:

In Finnish women aged 50 years or older, the use of any postmenopausal hormone replacement therapy (HRT) was linked to a higher risk for developing glaucoma, with estrogen-only therapy specifically associated with the risk for primary open-angle glaucoma.

METHODOLOGY:

• Researchers conducted a nested case-control study to examine if the use of exogenous estrogen‑only, progestogen‑only, or combined estrogen-progestogen HRT was associated with the development of glaucoma in postmenopausal women.
• They analyzed data of 1096 Finnish women aged 50 years or older who developed glaucoma between January 2015 and December 2017 and compared them with 5480 age‑matched female control individuals.
• Exposure to HRT was assessed from redeemed prescriptions during the 20 years before the development of glaucoma; at least two prescriptions per year must have been redeemed for inclusion in the analysis.
• A subgroup analysis involved 654 patients with primary open-angle glaucoma and 3270 age-matched control individuals.

TAKEAWAY:

• Overall, 60.6% of women who developed glaucoma and 53.1% of women in the control group had exposure to HRT.
• The use of any HRT was associated with a 36% higher risk for glaucoma (adjusted odds ratio [OR], 1.36; 95% CI, 1.19-1.56), with estrogen-only users having a 33% higher risk, progestogen-only users having a 25% higher risk, and combined therapy users having a 19% higher risk.
• In the subgroup of patients with primary open-angle glaucoma, the use of any HRT remained associated with an increased risk for the subtype (adjusted OR, 1.35; 95% CI, 1.13-1.62); those who received estrogen‑only therapy had a 31% higher risk, whereas those who received progestogen‑only and combined therapies did not show clear associations.
• Longer exposure to HRT, particularly estrogen-only therapy, was consistently associated with a higher risk for glaucoma.

IN PRACTICE:

“Three types of exogenous postmenopausal HRT (estrogen-only, progestogen-only, and combinatory estrogen-progestogen) are associated with the increased incidence of any glaucoma in a Finnish population-based cohort,” the researchers reported.

SOURCE:

The study was led by Sirpa Loukovaara, MD, PhD, of Helsinki University Hospital in Helsinki, Finland. It was published online on April 12, 2026, in Acta Ophthalmologica.

LIMITATIONS:

Identifying glaucoma from prescription records may have included people with ocular hypertension rather than confirmed glaucoma because some pressure‑lowering drugs are given to patients without a definitive diagnosis. Women taking HRT may also have more frequent medical visits, which could increase the chance that primary open-angle glaucoma is detected. Use of hormonal therapy may be linked with other health behaviors or conditions that themselves influence glaucoma risk. 

DISCLOSURES:

The study did not receive any grants from funding agencies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.