Hormone Therapy and Blood Clots

“Transdermal routes of administration
and lower doses of hormone therapy
may decrease risk of venous thromboembolism and stroke”.1

Umbrella
What may the Hormone Therapy and Blood Clots Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Blood Clots
  • Deep Vein Thrombosis (DVT)
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Menopausal Hormone Therapy (MHT)
  • Venous Thromboembolism (VTE)
  • Venous Thrombosis

Blood Clot Risk

What is the association between hormone therapy (HT) and blood clot risk?

On page one in Deciding About Hormone Therapy Use: Potential Risks, published July 2022, the North American Menopause Society (NAMS) note:

“Hormone therapy might slightly increase your risk of stroke or blood clots in the legs or lungs (especially if taken in pill form)”.2

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT – Blood Clots (Venous Thromboembolism) the (British) National Institute for Health and Care Excellence (NICE) guidelines note:

“HRT tablets (but not patches or gels) are linked with a higher risk of developing a blood clot.

If you are already at higher risk of blood clots (for example, you are obese) and you are considering HRT, you may be offered patches or gel rather than tablets.

If you have a strong family history of blood clots or if there’s another reason why you are at high risk of blood clots, you may be referred to a haematologist (a doctor who specialises in blood conditions) before considering HRT”.3

Transdermal

What is the association between transdermal administration of estradial and blood clots?

On page one in The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement, published 07 July 2022, the NAMS note:

“Transdermal routes of administration and lower doses of hormone therapy may decrease risk of venous thromboembolism and stroke”.4

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “Transdermal administration of estradiol is unlikely to increase the risk of venous thrombosis or stroke above that in non-users and is associated with a lower risk compared with oral administration of estradiol. The transdermal route should therefore be considered as the first choice route of estradiol administration in women with related risk factors”.5

Health Care Provider

If I choose to use HT, what is my risk of blood clots?

Different women who choose to use HT can have different risks of blood clots. It may therefore be in your best interest to also choose to talk to your health care provider about this.

On page one in Deciding About Hormone Therapy Use the NAMS elaborate on :

“Every woman is different, and you will decide about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare professional will be able to help you with your decision”.6

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement. 07 July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/press-release/ht-position-statement-release.pdf Accessed: 12 February 2023
  2. Deciding About Hormone Therapy Use: Potential Risks. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 12 February 2023
  3. Menopause Diagnosis and Management: Information for the Public – Benefits and Risks of HRT: Blood Clots (Venous Thrombolembolism). Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Accessed: 12 February 2023
  4. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement. 07 July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/press-release/ht-position-statement-release.pdf Accessed: 12 February 2023
  5. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 12 February 2023
  6. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 12 February 2023
Topic Last Updated: 07 March 2023 – Topic Last Reviewed: 12 February 2023

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