Can I take HRT if I have a risk of a blood clot?

When women reach the menopause, many suffer with debilitating symptoms due to a reduction in hormones. The most effective treatment to reduce these symptoms is HRT. Unfortunately, many women have been incorrectly told that HRT is not suitable for them if they have a history (or are at a high risk) of developing a blood clot.

Blood clots can occur in a deep vein (Deep Vein Thrombosis) or break off and travel to the lungs (Pulmonary Embolism) and can be very serious.

There are certain conditions and treatments that can raise the risk of getting a blood clot, such as some cancers or lupus.

Unfortunately, many women are being told incorrectly that HRT is not suitable for them if they’ve had a clot in the past or have a condition that raises their chance of getting a clot.

This is because, in the past, older types of HRT did slightly raise the risk of getting a blood clot and healthcare professionals aren’t always aware of up-to-date information and the latest evidence about newer types of HRT.

The estrogen part of HRT can be taken in tablet form (oral) or through the skin (transdermal). The increased risk of getting a blood clot is only with oral estrogen but there’s no extra risk with transdermal estrogen.

The safest way to take estrogen is via a patch, gel or spray, as this will not raise your risk of getting a clot.

If you take estrogen in any form (and still have your womb) you will need to take a progesterone to keep your womb lining thin and healthy. There are two types of progesterone – micronised progesterone and older, synthetic progestogens. While older progestogens are linked with an increased risk of clot, micronised progesterone does not have an increased risk of clot.

The safest way to take progesterone is micronised progesterone, known as Utrogestan.

Studies show transdermal estrogen and micronised progesterone do not increase the risk of clot for women with cancer, lupus, and clotting disorders such as Factor V Leiden. If your doctor has told you HRT is not safe because you have a risk of clot, this is incorrect information. You could try and see another doctor who is more informed about HRT.

This is one of many expert articles written by Dr Louise Newson, available in the free balance menopause app. 

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