Venous thromboembolism

Women should be assessed for VTE related risk factors prior to starting HRT.

• Where a moderate or high risk factor for VTE is present, or if multiple risk factors are present, consider referral to or seeking advice from a menopause specialist or haematologist prior to initiating HRT so that more detailed counselling can be given.
• Where a low risk factor for VTE is present, avoid HRT preparations containing oral oestrogen and consider the transdermal route in preference.
• Where a transient risk factor for VTE is present, consider referral or seeking advice from a menopause specialist or haematologist prior to initiating HRT. Once this risk factor has been removed the persons risk will be expected to return to baseline risk.

MODERATE OR HIGH RISK FACTORS FOR VTE:

• Previous VTE.
• Thrombophilia.
• Antiphospholipid syndrome.
• Significantly reduced mobility that is permanent, for example spinal cord injury.
• Active cancer.

LOWER OR MINOR RISK FACTORS FOR VTE:

• Age >60 years.
• Being overweight or obese.
• Active smoker.
• Varicose veins and superficial thrombosis.
• Family history of VTE.

TRANSIENT RISK FACTORS FOR VTE:

• Recent major surgery within the last 2 months.
• Arthroscopic hip or knee surgery in the last 2 months.
• Reduced mobility that is expected to be short-term, for example due to a lower limb fracture.
• Pregnancy or in the first 6 weeks post-partum.
• Central venous lines.