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Venous thrombo-embolism and hormone replacement therapy
1Menopause Clinic, Kings College Hospital, UK.
Bailliere'S Clinical Obstetrics and Gynaecology
|March 7, 1998
Summary
Hormone replacement therapy (HRT) may increase the risk of venous thrombo-embolism, though the absolute risk is small. Weigh HRT benefits against this risk, especially for those with a history of blood clots.
Area of Science:
- Reproductive Medicine
- Cardiovascular Health
- Pharmacology
Background:
- Recent data links hormone replacement therapy (HRT) to an elevated risk of venous thrombo-embolism (VTE).
- While relative risk is higher, the absolute VTE risk remains small.
- Potential biases in epidemiological studies and poorly understood mechanisms warrant careful consideration.
Purpose of the Study:
- To analyze the association between HRT and VTE risk.
- To contextualize the VTE risk against the established benefits of HRT.
- To provide guidance on HRT use in patients with or without VTE risk factors.
Main Methods:
- Review of epidemiological data on HRT and VTE.
- Clinical risk-benefit analysis of HRT.
- Discussion of potential mechanisms and patient screening strategies.
Main Results:
- HRT is associated with an increased relative risk of VTE, potentially due to unmasking thrombophilia or interacting with other risk factors.
- The absolute risk of VTE with HRT is small but warrants clinical consideration.
- HRT benefits, such as menopausal symptom relief and osteoporosis prevention, must be weighed against VTE risks.
Conclusions:
- HRT should be used cautiously in patients with a history of VTE or thrombophilia, with potential avoidance or antithrombotic therapy recommended.
- Screening for thrombophilia may be considered for high-risk individuals and their relatives.
- In patients without risk factors, the increased VTE risk is small, greatest in the first year, and requires individualized assessment against HRT benefits.