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How safe is it to prescribe hrt in a perimenopausal lady with a previous history of PE?

Associated tags: Cardiovascular disease, history, hrt, perimenopause, pulmonary embolism, Women's health

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Question answered:22/11/09

The CKS guideline on the menopause [1] has a section on contraindications to HRT [2], this lists the following:

- Hormone-dependent cancer (e.g. endometrial cancer, current or past breast cancer).

- Active or recent arterial thromboembolic disease (e.g. angina or myocardial infarction).

- Venous thromboembolic disease, pulmonary embolism, or current pregnancy.

- Severe active liver disease.

- Undiagnosed breast mass.

- Uninvestigated abnormal vaginal bleeding.

It suggests seeking specialist advice for women who would like HRT but who have a contraindication. They also have a section on managing symptoms without HRT [3], which might be of interest.

The RCOG have a 2004 guideline ‘Hormone replacement therapy and venous thromboembolism’ [4] which discusses a number of scenarios, one of which is a personal history of VTE. This reports:

“It is recommended that, in women with a previous VTE, with or without an underlying heritable thrombophilia, oral HRT should usually be avoided in view of he relatively high risk of recurrent VTE.”

We recommend you read the guidance in full as it gives a number of other related management options.

References

1) http://www.cks.nhs.uk/menopause
2) http://www.cks.nhs.uk/menopause/management/prescribing_information/hormone_replacement_therapy_hrt/contraindications
3) http://www.cks.nhs.uk/menopause/management/detailed_answers/managing_symptoms_without_hrt
4) http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT19HRTVenousThromboembolism2004.pdf

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