Why does HRT increase risk of blood clots?

Hormone replacement therapy (HRT) involves taking estrogen, progestogen, or a combination of both to treat menopausal symptoms like hot flashes, vaginal dryness, and sleep problems. However, HRT does come with some health risks, including an increased chance of developing blood clots.

Why HRT Raises Clotting Risk

There are several reasons why taking HRT medications can raise clot risk:

• Estrogen promotes clotting by increasing certain clotting factors in the blood and decreasing natural anticoagulants. It also causes inflammation and changes to vascular endothelium that make clots more likely to form.


• Progestogen can amplify estrogen's clot-promoting effects. Certain types like norethisterone acetate seem to pose a higher risk.


• HRT delivery method impacts risk. Oral tablets enter the liver first, raising clotting factor production. Transdermal patches/gels avoid this "first pass" effect.


• Patient risk factors like obesity, smoking, hypertension, previous clots, etc. can further increase chances of clots occurring.

How Significant Is the Increased Risk?

• For oral tablet HRT, studies indicate roughly a 2-4 times higher risk of blood clots compared to non-users.


• Transdermal HRT only seems to raise clotting risk by about 1.2 times.


• Absolute clot risk is still small for most healthy women on HRT. But those with multiple risk factors could see more substantial increases.

Reducing HRT Clotting Risks

If you've been prescribed HRT, there are things you can do to minimize any elevation in clot risk:

• Use transdermal gel/patches instead of oral tablets. This avoids first pass metabolism effects.


• Take the lowest effective HRT dose needed to relieve menopause symptoms.


• If taking oral HRT, consider using micronized progesterone over synthetic progestins.


• Discuss your personal and family clotting risk with your doctor. Get appropriate screening before starting HRT.


• Make lifestyle changes like losing excess weight, increasing activity, stopping smoking, and eating a Mediterranean-style diet.


• Learn about signs and symptoms of blood clots so you can seek prompt medical care if needed.

We offer personalized HRT treatment plans to help balance menopause relief with your safety at Equilibrium Hormone Institute(). Contact us today to learn more!

Signs of HRT-Related Blood Clots

If you experience any of the following symptoms while on HRT, seek medical care immediately as they could indicate a blood clot:

• Deep vein thrombosis (DVT)
  
  
  • Swelling, pain, warmth, and redness in one leg
  
  
  • Only noticeable in one limb
  
  


• Pulmonary embolism (PE)
  
  
  • Shortness of breath/rapid breathing
  
  
  • Sharp chest pain - may worsen with deep breath
  
  
  • Rapid heart rate
  
  
  • Lightheadedness, fainting
  
  


• Retinal vein thrombosis
  
  
  • Vision changes like blurry vision
  
  
  • Complete or partial vision loss
  
  
  • Eye pain
  
  
  • Red eye
  
  


• Stroke
  
  
  • Numbness or weakness on one side
  
  
  • Severe headache with no known cause
  
  
  • Confusion, difficulty speaking
  
  
  • Vision problems, dizziness
  
  

| Type of Clot | Location | Symptoms |
|:-------------|--------:|:---------|
| Deep vein thrombosis (DVT) | Leg veins |

• Swelling, pain, warmth, and redness in one leg


• Only noticeable in one limb

|
| Pulmonary embolism (PE) | Lungs |

• Shortness of breath, rapid breathing
• Sharp chest pain
• Rapid heart rate
• Lightheadedness, fainting

|
| Retinal vein thrombosis | Eye |

• Vision changes like blurry vision


• Complete or partial vision loss
• Eye pain
• Red eye

|
| Stroke | Brain |

• Numbness or weakness on one side


• Severe headache
• Confusion, difficulty speaking
• Vision problems, dizziness

|

So in summary, HRT can raise blood clot risks due to its impacts on clotting factors and vascular endothelium. However, using transdermal preparations, taking the lowest effective dose, and minimizing other clot risks can help keep this side effect rare for most women. Being aware of any (/hrt-clots) is also key for getting prompt treatment if a clot does occur. Discuss your HRT options thoroughly with your menopause specialist for optimal safety and relief of your menopause symptoms long-term.