Venous thromboembolism
- 11 Dec 2023
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Venous thromboembolism
- Updated on 11 Dec 2023
- 1 Minute to read
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- HRT preparations that contain oral oestrogen are associated with an increased risk of VTE by 2-4-fold, and this risk is greatest in the first year after initiation.
- The synthetic progestogens medroxyprogesterone acetate (Provera) and norethisterone may increase VTE risk.
- In contrast observational data suggests that transdermal HRT, when given at licensed doses, does not increase VTE risk and this remains the case whether the transdermal preparation is oestrogen only or a combined type.
- Micronised progesterone and the Mirena coil also likely represent safe options that are unlikely to increase VTE risk above a user’s baseline risk.
- NICE says the risk of VTE is increased by oral HRT compared with baseline population risk. The risk associated with transdermal HRT given at standard therapeutic doses is no greater than baseline population risk.
NOTE:
Where a risk factor for VTE is present, transdermal HRT, micronised progesterone and the Mirena coil represent safe options that are unlikely to increase risk further and should be used first line. In contrast, preparations containing oral oestrogen should be avoided.
References and Further Information:
- Hamoda H, Panay N, Pedder H et al. The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Found on page 193-194. Post Reprod Health 2020.
- National Institute for Health and Care Excellence. Guideline. Menopause (update). Draft for consultation, Nov 2023.
- Vinogradova Y, Coupland C and Hippisley-Cox J et al. Use of hormone replacement therapy and risk of venous thromboembolism: nested case control studies using the QResearch and CPRD databases. BMJ. 2019
- Rovinski D, Ramos R, Fighera T et al. Risk of venous thromboembolism events in postmenopausal women using oral versus non oral hormone therapy: a systematic review and meta-analysis. Thromb Res. 2018.
- Tepper N, Whiteman M, Marchbanks P et al. Progestin only contraception and thromboembolism: a systematic review. Contraception. 2016.
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