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. 2024 Apr 2:46:e-FPS02.
doi: 10.61622/rbgo/2024FPS02. eCollection 2024.

Use of hormones and risk of venous thromboembolism

Venina Isabel Poço Viana Leme de Barros  1 , André Luiz Malavasi Longo de Oliveira  1 , Denis Jose do Nascimento  2 , Eduardo Zlotnik  3 , Marcelo Melzer Teruchkin  4 , Marcos Arêas Marques  5   6 , Paulo Francisco Ramos Margarido  7
Affiliations

Use of hormones and risk of venous thromboembolism

Venina Isabel Poço Viana Leme de Barros et al. Rev Bras Ginecol Obstet. .

Abstract

•The risk of venous thromboembolism (VTE) is not increased in women using long-acting reversible contraceptive methods (LARCs) with progestogens. •Oral contraceptives with levonorgestrel or norgestimate confer half the risk of VTE compared to oral contraceptives containing desogestrel, gestodene or drospirenone. •Progestogen-only pills do not confer an increased risk of VTE. •Women using transdermal contraceptive patches and combined oral contraceptives (COCs) are at an approximately eight times greater risk of VTE than non-users of hormonal contraceptives (HCs), corresponding to 9.7 events per 10,000 women/years. •Vaginal rings increase the risk of VTE by 6.5 times compared to not using HC, corresponding to 7.8 events per 10,000 women/years. •Several studies have demonstrated an increased risk of VTE in transgender individuals receiving hormone therapy (HT). •Hormone therapy during menopause increases the risk of VTE by approximately two times, and this risk is increased by obesity, thrombophilia, age over 60 years, surgery and immobilization. •The route of estrogen administration, the dosage and type of progestogen associated with estrogen may affect the risk of VTE in the climacteric. •Combined estrogen-progesterone therapy increases the risk of VTE compared to estrogen monotherapy. •Postmenopausal HT increases the risk of thrombosis at atypical sites.

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Conflict of interest statement

Conflicts of interest: none to declare.

Figures

Figure 1
Figure 1. Flowchart of recommendations for the use of contraceptives and risk of venous thromboembolism
VTE: venous thromboembolism; COCs: combined oral contraceptives; LARCs: long-acting reversible contraceptives
Figure 2
Figure 2. Flowchart for deciding on hormonal treatment or not in the climacteric and risk of venous thromboembolism.
*The main acquired risk factors are described. There may be others. $Counseling means being alert to the signs of VTE risk, as well as avoiding risky situations such as immobilization, dehydration and planning surgeries. HT: hormone therapy; VTE: venous thromboembolism; APS: antiphospholipid syndrome; BMI: body mass index Source: Adapted from Lekovic et al. (2017).(32)
See this image and copyright information in PMC

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