Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis

Abstract

Objective To assess the risk of venous thromboembolism in women using hormone replacement therapy by study design, characteristics of the therapy and venous thromboembolism, and clinical background. Design Systematic review and meta-analysis. Data sources Medline. Studies reviewed Eight observational studies and nine randomised controlled trials. Inclusion criteria Studies on hormone replacement therapy that reported venous thromboembolism. Review measures Homogeneity between studies was analysed using χ 2 and I 2 statistics. Overall risk of venous thromboembolism was assessed from a fixed effects or random effects model. Results Meta-analysis of observational studies showed that oral oestrogen but not transdermal oestrogen increased the risk of venous thromboembolism. Compared with non-users of oestrogen, the odds ratio of first time venous thromboembolism in current users of oral oestrogen was 2.5 (95% confidence interval 1.9 to 3.4) and in current users of transdermal oestrogen was 1.2 (0.9 to 1.7). Past users of oral oestrogen had a similar risk of venous thromboembolism to never users. The risk of venous thromboembolism in women using oral oestrogen was higher in the first year of treatment (4.0, 2.9 to 5.7) compared with treatment for more than one year (2

Effets membranaires du récepteur alpha des œstrogènes

“…Il inhibe le pic d'hormone lutéinisante (LH), et donc l'ovulation, mais ne provoque pas de changement dans la synthèse des facteurs hépatiques circulants (C. Kluft Cornelis et al, manuscrit en préparation) [50]. Il pourrait ainsi ne pas influer sur les événements participant à la thrombose veineuse, contrairement aux produits pharmaceutiques comprenant de l'E2 ou de l'éthinyloestradiol [48]. Des données préliminaires indiquent clairement que dans le foie, la régulation de l'expression des gènes par ER repose à la fois sur les effets nucléaires et membranaires du récepteur.…”

Laboratory Investigation of Thrombophilia / LABORATORIJSKO ISPITIVANJE TROMBOFILIJA

“…It is known that exogenous estrogens used in the combined OC and HRT are associated with an increased relative risk for VTE (65)(66)(67). Also, the combination of OC or HRT use with well-defined hereditary or acquired thrombophilic risk factors further increases the risk for VTE (68)(69)(70).…”

Deep vein thrombosis in a transgender woman

“…A meta-analysis of observational studies involving women after menopause showed a superior safety profile for transdermal therapies. 6 Transgender hormone therapy and risk of VTE High rates of VTE in male-to-female people have been attributed to historic use of ethinyl estradiol, which is no longer recommended. 1 The aim of treatment is to maintain an age-appropriate physiologic range of hormones, which can be monitored with estradiol levels.…”