Most of my patients for whom I prescribe hormone therapy know that I prefer to prescribe FDA approved transdermal estrogen via a patch, gel or cream rather than oral pills. I love it when an article comes out in a peer-reviewed journal that affirms my choice. A new “you’re right” study was published this March in the journal Menopause. (The one with a red cover). It is titled “Risk of venous thromboembolism associated with local and systemic use of hormone therapy in peri-and postmenopausal women and in relation to type and route of administration”. I know this is a long title but medical journals often have to explicitly headline an article in order to entice physicians to read it.
The authors took the marvelously well kept records from the Swedish health care system and included 838 cases of women who were diagnosed with deep vein clots (venous thromboembolism or VTE) and compared them to 891 controls. The mean age of the women was 55. The two groups were matched with regards to smoking, body mass and immobilization. They found that oral estrogen with a progestogen increased the risk of VTE 2.8 fold. Oral estrogen only (in women who, I assume, had a previous hysterectomy and did not need progestogen when given estrogen) increased the risk by 1.3 fold. But here is the good news…transdermal estrogen combined with a progestogen was not associated with VTE risk, nor was local vaginal estrogen.
All forms of hormone therapy have their pros and cons. But transdermal estrogen does not seem to be associated with an increased risk of VTE, which can potentially lead to pulmonary embolism.