If you are at risk of clot of have had one in the past, discover what HRT is available to you
• Some women are incorrectly told HRT is not suitable for them if they have a history (or are at high risk of) a blood clot
• HRT is the most effective treatment for perimenopausal and menopausal symptoms
• Natural, body identical HRT is safe, even for those with a higher risk of getting a clot
HRT is the first-line treatment for management of menopausal symptoms [1]. But if you have had a blood clot in the past or have a condition that increases your risk of developing a clot, you may wrongly believe you are unable to take HRT, or have been told so by a healthcare professional.
Let’s take a closer look at the science behind the issue.
About blood clots
Blood clots can occur in a deep vein, usually in your leg, which is known as deep vein thrombosis (DVT). If untreated, parts of the clot can break off and travel to your lungs where they can cause a blockage known as pulmonary embolism (PE), which can be very serious.
Both of these types of clots are known collectively as Venous Thromboembolism or VTE.
Symptoms of a DVT include unexplained pain, which can feel like a throbbing pain. There may also be swelling, usually in one leg (or arm), and a reddish/blue skin discoloration that is warm to touch.
Symptoms of a PE include sudden shortness of breath, chest pain that is sharp or stabbing (the pain may get worse when breathing in deeply), a rapid heart rate, and an unexplained cough that occasionally may bring up blood-streaked mucus.
Am I at risk of clot?
Women who are pregnant and those who take oral contraceptives have an increased risk of a blood clot developing.
Certain conditions can increase your risk of having a blood clot, such as some cancers or lupus. You are more likely to develop a clot if you are obese, a smoker or have had a clot in the past. There are some conditions that increase risk of clot (such a Factor V Leiden deficiency) that can run in families.
What does the evidence say about HRT and blood clots?
The risk of clot depends on the type of HRT.
If you take natural, body identical HRT there is no risk of clot. Oestradiol (oestrogen) delivered via a patch, gel or spray does not carry an increased risk of clot or stroke [2]. The oestradiol goes straight into your bloodstream, bypassing your liver (which produces clotting factors), so is also safe to take by women who have a high risk of clot or have had a clot in the past [3].
Some women require off-label (high) doses of oestradiol to achieve levels needed for symptom relief, which is due to variations in absorption. Newson Research has shown that off-label doses of transdermal oestradiol (delivered through the skin in a patch, gel or spray), are unlikely to increase risk of clot [4].
If you take oestrogen and still have your womb, you will need to take a progesterone to keep your womb lining thin and healthy. Progesterone has beneficial effects in the body [5] so many women who have had a hysterectomy take progesterone too. There are two types of progesterone – natural progesterone (either oral micronised progesterone or pessaries) and older, synthetic progestogens. Micronised progesterone does not have an increased risk of clot [6].
RELATED: Utrogestan (micronised progesterone) explained
Older types of progestogens are linked with an increased risk of clot [6], and there is a small increased risk of a clot or stroke if you take oestrogen in oral tablet form [2]. This risk is only small but increases if you have a higher risk of clot.
Testosterone used as a gel or cream is not associated with a risk of clot.
Can I reduce my risk of a blood clot?
There are many other ways to reduce the risk of experiencing a dangerous blood clot and these are just as important as being on the right type of HRT. Firstly, be aware of situations that might cause a clot, and secondly, do what you can to manage these risks when they happen:
Take care during hospital admissions: Drink plenty of water. If possible, move about and take regular walks. You will be prescribed preventative medication if at risk.
RELATED: Do I need to stop HRT before surgery?
Maintain a healthy weight and have a healthy diet: the risk of having a clot increases with body size. Ensure your diet contains lots of fibre, fruit and vegetables, protein, and vitamin and minerals, and avoid foods containing lots of saturated fats, salt, and sugar to help manage your risk.
Do regular exercise or physical activity: aim for 20 minutes of moderate exercise a day such as a walk, or do an activity such as a swimming, tennis or an exercise class for 50-75 minutes, two to three times a week.
Avoid long periods of inactivity: if you spend long periods of the day sitting down, remember to get up and move around. Take a break every hour - set a reminder to move in every hour of sitting.
Move during long journeys: when travelling long distances by plane, car or train, drink plenty of water but avoid drinking alcohol as this can be dehydrating. Avoid taking sleeping pills because they will enhance immobility. Try regular simple leg exercises such as flexing and circling your ankles and when possible, move about and take short walks.
Consider your contraception: some forms of contraception, such as the combined oral contraceptive pill, patch or ring, can increase your clot risk to your healthcare professional about using a method that does not have an increased risk of clot, such as barrier methods or the Mirena coil.
What’s the bottom line?
If you are experiencing menopausal symptoms and considering whether HRT is suitable for you, rest assured that body identical HRT is safe if you are at risk of developing or have had a blood clot in the past. Transdermal oestradiol, natural progesterone and testosterone as a gel or cream are the preferable options for you. Speak to a healthcare professional for an individualised conversation about HRT based on your medical history and menopause symptoms.
RELATED: Stroke, menopause and HRT: what you need to know