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Menopause, Estrogen and Venous Events

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The Menopause, Estrogen and Venous Events (MEVE) study was a retrospective observational study of menopausal hormone therapy and venous thromboembolism (VTE) in postmenopausal women with a previous history of VTE.[1][2][3][4][5] It found that transdermal estradiol was not associated with increased risk of VTE (HRTooltip hazard ratio = 1.0, 95% CITooltip confidence interval 0.4–2.4) whereas oral estrogens were associated with a large increase in risk (HR = 6.4, 95% CI 1.5–27.3).[1][3][4] The mean dose of transdermal estradiol in the study was 50 μg/day, although data on dose were missing for around 50% of women.[1][2] Similarly, a small study found that transdermal estradiol did not influence coagulation in women with prior VTE.[6] These findings are similar to studies in menopausal women without prior history of VTE which have found that transdermal estradiol has minimal influence on coagulation[7] and is not associated with increased risk of VTE at doses of up to 100 μg/day.[8][9][10][11] Menopausal hormone therapy guidelines have cited the MEVE study and recommended use of transdermal estradiol over oral estrogens in women at high risk for VTE.[12][13][14][15] However, randomized controlled trials (RCTs) are still needed to definitively confirm findings that transdermal estradiol is safer than oral estrogens in terms of VTE risk.[12][16][17]

See also

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References

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  1. ^ a b c Olié V, Plu-Bureau G, Conard J, Horellou MH, Canonico M, Scarabin PY (May 2011). "Hormone therapy and recurrence of venous thromboembolism among postmenopausal women". Menopause. 18 (5): 488–93. doi:10.1097/gme.0b013e3181f9f7c3. PMID 21178641. S2CID 20968536.
  2. ^ a b Lobo RA (May 2011). "Risk of venous thromboembolism by route of administration of estrogen". Menopause. 18 (5): 469–70. doi:10.1097/gme.0b013e318211745b. PMID 21407136.
  3. ^ a b Olié V, Canonico M, Scarabin PY (September 2010). "Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women". Curr Opin Hematol. 17 (5): 457–63. doi:10.1097/MOH.0b013e32833c07bc. PMID 20601871. S2CID 205827003.
  4. ^ a b Scarabin PY (2014). "Hormone therapy and venous thromboembolism among postmenopausal women". Front Horm Res. Frontiers of Hormone Research. 43: 21–32. doi:10.1159/000360554. ISBN 978-3-318-02673-3. PMID 24943295.
  5. ^ Simon JA (July 2014). "What if the Women's Health Initiative had used transdermal estradiol and oral progesterone instead?". Menopause. 21 (7): 769–83. doi:10.1097/GME.0000000000000169. PMID 24398406. S2CID 30292136.
  6. ^ Margarido PF, Bagnoli VR, Maggio da Fonseca A, Maciel GA, Soares JM, D'Amico EA, Baracat EC (2011). "Transdermal estrogen therapy effects on fibrinogen levels in women with a past history of venous thromboembolism: a pilot study". Clin Exp Obstet Gynecol. 38 (3): 232–5. PMID 21995153.
  7. ^ Hemelaar M, van der Mooren MJ, Rad M, Kluft C, Kenemans P (September 2008). "Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review". Fertil Steril. 90 (3): 642–72. doi:10.1016/j.fertnstert.2007.07.1298. PMID 17923128.
  8. ^ Rovinski D, Ramos RB, Fighera TM, Casanova GK, Spritzer PM (August 2018). "Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis". Thromb Res. 168: 83–95. doi:10.1016/j.thromres.2018.06.014. PMID 29936403. S2CID 49421543.
  9. ^ Scarabin PY (August 2018). "Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis". Climacteric. 21 (4): 341–345. doi:10.1080/13697137.2018.1446931. PMID 29570359. S2CID 4229701.
  10. ^ Oliver-Williams C, Glisic M, Shahzad S, Brown E, Pellegrino Baena C, Chadni M, Chowdhury R, Franco OH, Muka T (March 2019). "The route of administration, timing, duration and dose of postmenopausal hormone therapy and cardiovascular outcomes in women: a systematic review". Hum Reprod Update. 25 (2): 257–271. doi:10.1093/humupd/dmy039. PMID 30508190.
  11. ^ Vinogradova Y, Coupland C, Hippisley-Cox J (January 2019). "Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases". BMJ. 364: k4810. doi:10.1136/bmj.k4810. PMC 6326068. PMID 30626577.
  12. ^ a b Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ (November 2015). "Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 100 (11): 3975–4011. doi:10.1210/jc.2015-2236. PMID 26444994. S2CID 29118146.
  13. ^ Baber RJ, Panay N, Fenton A (April 2016). "2016 IMS Recommendations on women's midlife health and menopause hormone therapy". Climacteric. 19 (2): 109–50. doi:10.3109/13697137.2015.1129166. PMID 26872610. S2CID 9803286.
  14. ^ Tremollieres F, Brincat M, Erel CT, Gambacciani M, Lambrinoudaki I, Moen MH, Schenck-Gustafsson K, Vujovic S, Rozenberg S, Rees M (June 2011). "EMAS position statement: Managing menopausal women with a personal or family history of VTE". Maturitas. 69 (2): 195–8. doi:10.1016/j.maturitas.2011.03.011. PMID 21489728.
  15. ^ Goodman NF, Cobin RH, Ginzburg SB, Katz IA, Woode DE (2011). "American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of menopause". Endocr Pract. 17 (Suppl 6): 1–25. doi:10.4158/ep.17.s6.1. PMID 22193047.
  16. ^ Cobin RH, Goodman NF (July 2017). "American Association of Clinical Endocrinologists and American College of Endocrinology position statement on menopause–2017 update". Endocr Pract. 23 (7): 869–880. doi:10.4158/EP171828.PS. PMID 28703650.
  17. ^ "The 2017 hormone therapy position statement of The North American Menopause Society". Menopause. 24 (7): 728–753. July 2017. doi:10.1097/GME.0000000000000921. PMID 28650869.
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