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Hormone therapy and venous thromboembolism.
1Cardiology Unit, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia. roger.peverill@med.monash.edu.au
Summary
Hormone replacement therapy (HRT) significantly increases venous thromboembolism (VTE) risk in post-menopausal women, especially within the first year. This elevated risk is associated with various HRT formulations and may be amplified by genetic factors.
Area of Science:
- Reproductive Endocrinology
- Cardiovascular Health
- Pharmacovigilance
Background:
- Hormone replacement therapy (HRT) is commonly used by post-menopausal women.
- Venous thromboembolism (VTE) is a serious health concern.
- Previous studies indicated a potential link between HRT and VTE.
Purpose of the Study:
- To synthesize evidence on the association between HRT and VTE risk.
- To identify factors influencing HRT-related VTE risk.
- To clarify the VTE risk associated with different HRT types.
Main Methods:
- Review of randomized controlled trials and observational studies.
- Analysis of VTE risk across different HRT formulations (oral estrogen, combined HRT, transdermal HRT).
- Investigation of VTE risk in relation to HRT duration and thrombophilic states.
Main Results:
- HRT use is associated with a 2- to 3-fold increased risk of VTE.
- The highest VTE risk occurs in the first year of HRT use, persisting with ongoing use.
- Increased VTE risk is observed with oral estrogen alone, combined HRT, and likely transdermal HRT, affecting both idiopathic and non-idiopathic VTE.
Conclusions:
- HRT significantly elevates VTE risk in post-menopausal women.
- The risk is formulation-dependent and influenced by duration of use.
- Further research is needed to clarify the VTE risk of low-dose HRT and tibolone, and interactions with thrombophilia.