Introduction: Cerebral aneurysms rupture more often in postmenopausal women than in premenopausal women or men, however the role of hormones in this disparity is poorly understood. Prior studies suggest that estrogen is critical in maintaining arterial vascular integrity and tone. Use of oral contraceptive (OC) and hormone replacement therapy (HRT) attenuates the sudden physiologic drops in estrogen during the normal menstrual cycle and at menopause. The goal of this study was to compare the rate of exogenous estrogen use in a cohort of women with cerebral aneurysms with large-sample national averages.

Methods: A retrospective, case-control study was performed via structured telephone and in hospital interviews. Female patients with radiographically identified cerebral aneurysms were compared with a publically available data set from 4682 random female controls in the US (Annals of epidemiology 12(4): 213-22). The questions asked of both groups focused on gynecologic history (age of menarche, parity, use and duration of estrogen modifying medications, etc) and data were analyzed with univariate and multivariate statistics.

Results: Preliminary data include 60 cases of women with cerebral aneurysms (age 31 - 80 years). Chi-square and independent sample t-test analyses showed a statistically significant lower rate of OCP (OR = 2.1, CI = [1.17, 3.81], p = 0.01), and HRT (OR = 3.09, CI = [1.54, 6.22], p = 0.002) use among cases as compared to controls.

Conclusions: Women with cerebral aneurysms used OC and HRT significantly less frequently than the general population. These results support the hypothesis that physiologic drops in estrogen that occur during the menstrual cycle and particularly at menopause, may explain why cerebral aneurysms are more frequently found in women. A protective role for pharmacologic estrogen in women warrants further study.

Patient Care: This research supports the hypothesis that exogenous use of hormones might be protective for women against the development of intracerebral aneurysms.

Learning Objectives: The objective of this study is to evaluate for any unique endocrinologic features in our cohort of women with unruptured cerebral aneurysms.

References: Annals of epidemiology 12(4): 213-22