Venous thromboembolism in women: a specific reproductive health risk

Abstract

BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed by the European Society of Human Reproduction and Embryology Workshop Group. RESULTS VTE is a multifactorial disease with a baseline annual incidence around 50 per 100 000 at 25 years and 120 per 100 000 at age 50. Its major complication is pulmonary embolism, causing death in 1-2% of patients. Higher VTE risk is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together. In pregnancy, the risk of VTE is increased ~5-fold, while the use of combined hormonal contraception (CHC) doubles the risk and this relative risk is higher with the more recent pills containing desogestrel, gestodene and drospirenone when compared with those with levonorgestrel. Similarly, hormone replacement therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS Clinicians managing pregnancy or treating women for infertility or prescribing CHC and HRT should be aware of the increased risks of VTE and the need to take a careful medical history to identify additional co-existing risks, and should be able to diagnose VTE and know how to approach its prevention.

Testosterone treatment and risk of venous thromboembolism: population based case-control study

“…On an absolute population risk basis, the baseline and testosterone induced increases in risks of venous thromboembolism in this population of middle aged and older men are quantitatively comparable to the baseline (non-user) risks of venous thromboembolism in women and the increase among users of oral oestrogens in combined oral contraceptives or oestrogen replacement therapy for menopause 2930 31 32 The early increase in risk in the first six months is also similar to that seen with oral oestrogen therapy 19. An increased risk of venous thromboembolism in patients with underlying familial or acquired thrombophilia if treated with testosterone has also been hypothesised and could explain the increased risk within six months after starting testosterone treatment 33…”

Associations of Trauma Exposure and Posttraumatic Stress Symptoms With Venous Thromboembolism Over 22 Years in Women

“…VTE is characterized by high mortality rates and a high rate of recurrence among survivors,2 and it has been identified as an important health concern for women in particular 3. Furthermore, studying the link between PTSD symptoms and VTE specifically in a sample of younger and middle‐aged women has particular relevance for understanding VTE risk in women.…”

“…PTSD is twice as common in women as in men,11 and our findings suggest that elevated PTSD symptoms (over and above the effects of trauma type and depression, a psychological disorder that is frequently comorbid with PTSD and has also been linked with risk of VTE9, 10) may be an important vulnerability factor for developing VTE in women. Given that VTE is a leading cause of mortality among pregnant and recently postpartum women,3 and in light of female‐specific risk factors for VTE related to reproductive hormone exposure,3 pregnant women with PTSD symptoms or women with PTSD symptoms who are using hormone therapy may represent especially vulnerable groups with respect to VTE risk. Additional research in these particular populations is needed, but our findings highlight certain individuals who might benefit from close monitoring by healthcare providers in order to prevent possible VTE.…”

“…Although VTE has been identified as a major public health concern for men and women,2 certain factors make it particularly relevant to women's health 3. Female‐specific risk factors for VTE related to reproductive hormone exposure (eg, due to contraceptive therapy, pregnancy, and hormone therapy [HT]) have been documented,3 and VTE is a leading cause of mortality among pregnant and recently postpartum women in the United States 2. Additionally, VTE incidence rates are higher in women of childbearing age than in men of the same age,4, 5 likely reflecting VTE induced by pregnancy and/or oral contraceptive use during childbearing years.…”

“…Additionally, VTE incidence rates are higher in women of childbearing age than in men of the same age,4, 5 likely reflecting VTE induced by pregnancy and/or oral contraceptive use during childbearing years. Given the disease burden and highly recurrent nature of VTE—a largely preventable condition—greater insight into factors that may increase risk or promote prevention, particularly in women, is a significant public health priority 2, 3. Furthermore, given that 26% to 47% of VTE cases are classified as occurring in the absence of major established risk factors (eg, cancer, surgery, and pregnancy),6 better understanding of VTE risk has important clinical relevance.…”