[Hormone replacement therapy in menopause, hemostasis and thromboembolic risk]

The association between oral contraceptives and the risk of thrombosis is now well documented. Conversely, post-menopausal hormonal therapy with doses and types of estrogen vastly different, seems not conducive of venous thromboembolism. Clotting factor abnormalities which have occasionally been observed in patients receiving hormone replacement therapy appear to be relatively unimportant clinically. Since no study is available on the assessment of the risk of thrombosis with these treatment, any hormone replacement therapy should be contraindicated as a principle, in both patients with recurrent venous thrombosis with or without known hemostatic abnormality. This attitude could be modified, if the therapy is justified by osteopenia or clinical complaints, after consulting specialist in gynecology, endocrinology, angiology or rheumatology, informed of the risk arising from such hormonal therapies. In theses particular cases, hormonal therapy with the fewest metabolic effects could be used.