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Should I Stop HRT Before Surgery?

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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