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Postmenopausal hormone replacement therapy and venous thromboembolism
1Division of Developmental Medicine, Maternal and Reproductive Medicine, Glasgow Royal Infirmary, Scotland. o.wu@clinmed.gla.ac.uk
Gender Medicine
|March 23, 2006
Summary
Women using hormone replacement therapy (HRT) face an elevated risk of venous thrombosis, particularly in the first year of use. Risk varies by HRT type, dosage, and individual factors like thrombophilia.
Area of Science:
- Reproductive Endocrinology
- Thrombosis Research
- Pharmacovigilance
Background:
- Hormone replacement therapy (HRT) use is associated with a 2- to 5-fold increased risk of venous thrombosis.
- Risk elevation may vary based on estrogen type, delivery method, and co-existing risk factors.
Purpose of the Study:
- To systematically review current literature on the varying risks of venous thrombosis in women using HRT.
- To identify factors influencing the magnitude of this risk.
Main Methods:
- Conducted an extensive literature search of major electronic databases (MEDLINE, EMBASE) from 1980 to October 2005.
- Utilized keywords related to thrombosis (venous thromboembolism, DVT, PE) and hormones (HRT, estrogen).
Main Results:
- The risk of venous thrombosis ranged from 1.22 to 4.50-fold higher in HRT users versus non-users.
- Risk is highest in the first year of HRT (up to >6-fold increase).
- Estrogen-progestin HRT, oral administration, high-dose estrogen, thrombophilia (e.g., Factor V Leiden), older age, and obesity further amplify thrombosis risk.
Conclusions:
- Current HRT users have a confirmed increased risk of venous thrombosis.
- Risk is greatest in the first year and influenced by HRT type, preparation, and additional risk factors (age, obesity, cancer, surgery).
- Further research is needed on the interplay between thrombophilia, HRT, and venous thrombosis risk.