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Menopause - Management
How should I manage a woman with a personal or family history of thromboembolic disease or with a known thrombophilia disorder?

Basis for recommendation
  • These recommendations are based on published expert opinion [RCOG, 2004; ICSI, 2006].
  • Women with a personal or family history of thromboembolic disease should avoid using oral hormone replacement therapy (HRT) (in view of the relatively high risk of recurrent venous thromboembolism [VTE]) unless it is taken with anticoagulation therapy:
    • Transdermal therapy may be a better option, but specialist advice should be sought.
    • Evidence indicates that oral HRT and not transdermal HRT is associated with an increased risk of VTE.
    • Transdermal therapy is thought to have less effect on coagulation than oral administration because oral preparations undergo first-pass hepatic metabolism and therefore have a greater effect on factors produced by the liver than transdermal preparations, which avoid the first-pass effect.
  • Women with a known thrombophilia disorder:
    • In general, women with antithrombin defects, or combinations of other clotting defects, and Factor V Leiden homozygosity should avoid HRT, unless it is taken with anticoagulation therapy (these women should be managed via specialist centres).
    • Evidence is insufficient to recommend that women with other clotting defects completely avoid HRT. However, HRT should be avoided in the presence of multiple risk factors for VTE in these women (e.g. varicose veins, obesity).

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