If you are at risk of clot of have had one in the past, discover what HRT is available to you
HRT is the first line treatment for management of menopausal symptoms [1]. But if you have had a blood clot in the past or have a condition that increases your risk of developing a clot, you may wrongly believe you are unable to take HRT, or have been told so by a healthcare professional.
Let’s take a closer look at the science behind the issue.
About blood clots
Blood clots can occur in a deep vein, usually in your leg (known as deep vein thrombosis), and they can break off and travel to your lungs (pulmonary embolism), which can be very serious.
Certain conditions and treatments can increase your risk of getting a blood clot, such as some cancers or lupus. You are more likely to develop a clot if you are obese, a smoker or have had a clot in the past. There are some conditions (such a Factor V Leidin deficiency) that can run in families.
What does the evidence say about HRT and blood clots?
There is a small increased risk of a clot or stroke if you take oestrogen in oral tablet form [2]. This is because when oestrogen is taken as a tablet, it is metabolised in your liver, which produces clotting factors. This risk is only small but increases if you have a higher risk of clot.
However, oestradiol (oestrogen) delivered via a patch, gel or spray does not carry an increased risk of clot or stroke [3]. The oestradiol goes straight into your bloodstream, so bypassing your liver (which produces clotting factors) so is safe to take by women who have a high risk of clot or have had a clot in the past [4].
If you take oestrogen in any form and still have your womb, you will need to take a progesterone to keep your womb lining thin and healthy. Progesterone has beneficial effects in the body [5] so many women who have had a hysterectomy take progesterone too.
There are two types of progesterone – natural progesterone (either oral micronised progesterone or pessaries) and older, synthetic progestogens. While older types of progestogens are linked with an increased risk of clot, micronised progesterone does not have an increased risk of clot [6].
RELATED: Utrogestan (micronised progesterone) explained
Testosterone used as a gel or cream is not associated with a risk of clot.
What’s the bottom line?
Body identical HRT is still safe if you are at risk of developing or have had a blood clot in the past. Transdermal oestradiol, natural progesterone and testosterone as a gel or cream are the preferable options for you. Speak to a healthcare professional for an individualised conversation about HRT based on your medical history and menopause symptoms.
