HRT and Blood Clot

 


Venous Thromboembolism or thrombosis is the formation of a blood clot inside of the blood vessels. This health issue blocks blood flow in the blood vessels or breaks free and travels elsewhere in the body. If a clot gets stuck in some body organs, like lungs or brain, it disrupts blood flow and results in a life-threatening emergency. 

Deep vein thrombosis (DVT) forms in a deep vein (particularly in the legs, arms or pelvis. If a blood clot from a DVT breaks loose and travels through the bloodstream, it sticks in the pulmonary arteries (the arteries that carry blood to the lungs), blocks blood flow, and causes a pulmonary embolism (PE). 

Pulmonary embolism is dangerous. According to Mayo Clinic, about one-third of people with an undiagnosed and untreated pulmonary embolism don't survive. However, early treatment and diagnosis will reduce its mortality rate. 

Chest pain, trouble breathing, and skin changes are the symptoms of clot locations.

Risk Factors of Blood Clotting

Hospital admission for any illness - Drink plenty of water and take a walk when you’re able to.

Overweight and an unhealthy diet - Maintain a healthy weight and stuff your diet with foods rich in protein, vitamins, minerals, and fiber. Avoid saturated fats, salt, and sugar.

Little exercise - A moderate 20-minute exercise everyday regulates blood flow.

Long periods sitting down - Prolonged sitting slows down blood flow and allows blood to pool, particularly in the legs. Avoid sitting for more than 2 hours without a 15-minute stretch break.

Birth Control and HRT Risks

Men and women are at risk of DVT but women are more likely to be at risk of this health condition due to pregnancy, birth control, and menopause hormone replacement therapy. These risks are linked to estrogen, a key ingredient in birth control and menopause hormone therapy. 


To be clear, estrogen doesn’t cause blood clots but it increases the risk by promoting the production of proteins that facilitate clotting and reducing the levels of natural anticoagulants.


There’s a small risk of blood clot for women taking pills. According to the National Blood Clot Alliance, 1 in 3,000 women taking birth control pills yearly will develop a blood clot. However, the risk is big if a woman has thrombosis history (thrombophilia).

For women taking hormone replacement therapy, blood clot risk is associated with older types of estrogen (conjugated equine estrogen) and older synthetic progestogens. This study is from the Women Health Initiative.

Right now, there are newer types of estrogen and the risk is still there, particularly with oral estrogen tablets. 

According to studies, high estrogen levels in the liver occur when estrogen tablets are taken orally. This leads to sticky blood changes that increase the risk of VTE. On average, what is the risk?

As per The Menopause Charity example, imagine a healthy woman of 50 years of age. She has a VTE risk of around 6 in 10,000 per year. If she took oral estrogen tablets, this would double her risk to around 12 in 10,000 but it’s still a small risk overall.

To avoid blood clot issues, doctors prescribe transdermal estrogen as it’s much safer, does not cause sticky blood changes, and does not increase the risk of clotting. Transdermal estrogen comes in patch, gel, and spray. 


How about progesterone?

  • According to the Healthline article, micronized progesterone made from yam root vegetable doesn’t pose blood clot risks.
  • Synthetic progesterone (medroxyprogesterone acetate (MPA), dydrogesterone, levonorgestrel, or drospirenone) have a small increased risk of clot.
Health Conditions that Increase Blood Clotting when Taking HRT
  • Women with lupus have a 3-4 times higher risk of thrombosis and increased osteoporosis if they took high doses of treatment.
  • Postmenopausal women with Factor V Leiden have a 3-4 times greater risk of VTE than women their age who do not have Factor V Leiden. Women with Factor V Leiden taking oral estrogen have 25 times VTE risk. However, women with Factor V Leiden taking transdermal estrogen did not show any greater risk of clot than the 3-4 times higher risk level from their condition.

Factor V Leiden is an inherited blood clotting disorder that increases risk of deep vein thrombosis or pulmonary embolism.

  • Cancer (pancreas, bowel, lung, stomach, ovary, womb cancers) and cancer treatments (chemotherapy) increase the risk of blood clots when taking oral HRT.

For example, tamoxifen (prescribed for women with breast cancer) increases the risk of blood clot but its benefits are considerable, so some doctors give an anticoagulant alongside tamoxifen to prevent clots.


Sources


Menopause and Clots

Venous Thrombosis Risk and Menopausal Treatments

What types of hormone replacement therapy are safe?

Women's Health




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