Perioperative Management of Female Hormone Medications

No clear guideline exists for the management of female hormone therapy in the perioperative period. Besides oral contraceptives (OCPs), hormone medications have been prescribed to treat cancer, osteoporosis, and menopausal symptoms. Since the introduction of OCPs in the 1960s, the thromboembolic risk associated with these medications has been studied and alterations have been made in the hormone content. The continuation of hormone therapy in the perioperative period and its possible interactions with commonly used anesthetic agents are important information for all perioperative health care providers.

A review was done on the current guideline and available literature for the mechanisms of action and perioperative management of OCPs, hormone replacement therapy (HRT), and antineoplastic hormonal modulators.

Available guidelines and literature were reviewed and summarized.

Based on the available literature, no definite guidelines have been established for perioperative management of OCPs and HRT. However, manufacturers have recommended that these medications should be held perioperatively. Other antineoplastic hormonal modulators have increased the risk of venous thromboembolism and have perioperative implications that should be discussed with the prescribing physicians and addressed with the patient.

Until additional studies are performed, the risks and benefits must be weighed on an individual basis with consideration of prophylaxis when a decision is made to continue these medications in the perioperative period. Part of this decision making includes the risk of fetal harm in an unwanted pregnancy in preparation for nonobstetric surgery versus an increased risk of venous thromboembolism.