Menopausal hormone therapy and incident benign paroxysmal positional vertigo in postmenopausal women: A prospective...

Menopausal hormone therapy and benign paroxysmal positional vertigo, a disorder linked to postmenopausal estrogen deficiency, have not been examined together in a large cohort. We assessed whether hormone therapy is associated with incident positional vertigo and its persistence after cessation.

We constructed a prospective cohort of 160,617 postmenopausal women from the UK Biobank, excluding prevalent cases, and ascertained hormone therapy status, duration, and time since cessation from self-report. Incident cases were modelled with cause-specific Cox regression on the attained-age scale, adjusting for sociodemographic, lifestyle, cardiometabolic, and comorbidity covariates.

Incident benign paroxysmal positional vertigo, from the first hospital (ICD-10 H81.1) or primary-care record.

In 157,245 women with complete covariate data (2627 events), the fully adjusted hazard ratio was 1.22 (95% confidence interval 1.09 to 1.38) for current use and 1.28 (1.17 to 1.39) for past use versus never use, stable across adjustment. Risk rose with duration (1.50 at 10 or more years; p for trend <0.001) and persisted after cessation (1.39 at 10 or more years since stopping). The duration-response relationship was stronger for recurrent than single-episode disease (hazard ratio at ten or more years, 1.83 versus 1.41). The association varied with attained age. Exploratory formulation and bone-mineral analyses were inconclusive.

Menopausal hormone therapy use was positively associated with incident positional vertigo, with a duration-response relationship and persistence after cessation. These pooled estimates are attained-age-averaged and hypothesis-generating; they warrant prospective validation and do not justify changing an individual woman's menopausal hormone therapy regimen.