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Should I Stop HRT Before Surgery?

Updated: Jul 17, 2024



If you’re facing major surgery, understanding how hormone replacement therapy (HRT) might impact your risk of blood clots is crucial. Here’s what you need to know:


Blood Clot Risk and Surgery


During surgery, there’s a heightened risk of blood clots forming, particularly in the legs (deep vein thrombosis, DVT) or potentially traveling to the lungs (pulmonary embolism, PE). This risk increases with immobility, common post-surgery.


Types of HRT and Clot Risk


Transdermal Estrogen: If you use estrogen patches, gels, , you typically won’t need to stop HRT before or after surgery. This form of estrogen doesn’t elevate clotting factors, making it safer during surgery recovery.


Oral Estrogen: Tablets may slightly increase clot risk due to liver metabolism. Some may need to stop oral estrogen weeks before major surgery, depending on individual clot risk and surgery type.


Progestogens: The type used affects clot risk:

Safe Options: Micronized progesterone (e.g., prometrium) and the Mirena coil (levonorgestrel) have low clotting risks.


Caution Needed: Synthetic progestogens (e.g., medroxyprogesterone acetate) could pose a small clot risk, especially orally.


Benefits of Continued HRT


General Health: Maintaining HRT can aid overall health, including bone density, heart health, and wound healing post-surgery.


Symptom Relief: HRT helps manage menopausal symptoms, supporting recovery and well-being during rehabilitation.


Precautions for Surgery


To minimize clot risks post-surgery:


1. Discuss your specific clot risk and HRT with your doctor.

2. Follow prescribed blood-thinning medications (e.g., heparin).

3. Consider using compression stockings and staying hydrated.

4. Stay mobile when possible, with gentle exercises like leg movements and short walks.


Understanding these factors and discussing them with your healthcare team ensures you make informed decisions about managing HRT during surgical periods.



See references [1], [2], [3], [4], [5], [6] for detailed studies on HRT and clot risks.


  1. Y, Coupland C, Hippisley-Cox J. Use of Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. British Medical Journal. 2019;364:k4810. doi: 10.1136/bmj.k4810.

2. Straczek C, et al. Estrogen and thromboembolism risk (ESTHER) study group. Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration. Circulation. 2005;112(22):3495–500. doi: 10.1161/CIRCULATIONAHA.105.565556.

3. Scarabin PY. Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis. Climacteric. 2018;21(4):341-345.

4. Van Hylckama Vlieg A, Helmerhorst FM, Rosendaal FR. The risk of deep venous thrombosis associated with injectable depot-medroxyprogesterone acetate contraceptives or a levonorgestrel intrauterine device. Arteriosclerosis, Thrombosis, and Vascular Biology. 2010;30(11):2297–2300.

5. Glaser R, Dimitrakakis C. Testosterone therapy in women: myths and misconceptions. Maturitas. 2013;74(3):230-234. doi: 10.1016/j.maturitas.2013.01.003.hormone


By Dr Purity

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Welcome to Purity Health Women’s Menopause and Wellbeing Centre™

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At Purity Health, we believe in living life to the fullest. Dr Purity Menopause Clinic, in association with Samy Medical Group, is dedicated to providing safe, evidence based information and care in perimenopause, menopause, histamine related conditions, and metabolic health.

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We recognise that there are many myths and misunderstandings surrounding menopause and Hormone Replacement Therapy, HRT. One commonly repeated belief is that oestrogen causes breast cancer. This is an oversimplification and does not reflect the full body of evidence.

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Here is the truth.

At Dr Purity Carr Menopause Clinic, we are committed to providing accurate information and personalised care.

Follow us on #drpuritycarr

Extensive evidence shows that for women within 10 years of menopause or under the age of 60, the benefits of HRT generally outweigh the risks.

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For women who start HRT during perimenopause or within 10 years of menopause, there is often no need to stop purely based on age. Ongoing use should be individualised and guided by clinical review.

Even for women who are further beyond menopause or over 60, starting HRT may still be considered under the guidance of a knowledgeable practitioner, with careful assessment of risks and benefits.

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A Broader Approach to Women’s Health

Dr Purity is a General Practitioner with a special interest in menopause care, taking a holistic, systems based approach to women’s health.

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In addition to menopause, her work now includes:

Hormone health, including perimenopause and menopause
Histamine related conditions, including suspected mast cell activation patterns
Metabolic health, including weight management, insulin resistance, and inflammation
The interaction between hormones, the immune system, and the nervous system

Many women experience symptoms that do not sit neatly within one system. Hormones do not operate in isolation. There is often an overlap between hormonal changes, histamine activity, and metabolic dysfunction. This integrated approach allows for a deeper understanding of symptoms such as fatigue, anxiety, poor sleep, weight gain, brain fog, and chronic inflammation.

 

Dr Purity’s Focus on Care

Dr Purity focuses specifically on menopause, histamine balance, and metabolic health. She works to identify underlying drivers of symptoms and supports women through evidence based, personalised care.

Please note that Dr Purity does not replace your general practitioner. The experienced doctors at Samy Medical, part of the same medical system as Purity Health, are available to manage your broader healthcare needs.

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