Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis

@article{Scarabin2018ProgestogensAV,
  title={Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis},
  author={Pierre-Yves Scarabin},
  journal={Climacteric},
  year={2018},
  volume={21},
  pages={341 - 345}
}
  • P. Scarabin
  • Published 23 March 2018
  • Medicine, Biology
  • Climacteric
Abstract Postmenopausal hormone therapy (HT) is a modifiable risk factor for venous thromboembolism (VTE). While the route of estrogen administration is now well recognized as an important determinant of VTE risk, there is also increasing evidence that progestogens may modulate the estrogen-related VTE risk. This review updates previous meta-analyses of VTE risk in HT users, focusing on the route of estrogen administration, hormonal regimen and progestogen type. Among women using estrogen-only… 
Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference
TLDR
Micronized progesterone and dydrogesterone appear to be the safest options, with lower associated cardiovascular, thromboembolic, and breast cancer risks compared with other progestogens, and are the first-choice options for use in ‘special situations,’ such as in women with high-density breast tissue, diabetes, obesity, smoking, and risk factors for venous throm boembolism.
Postmenopausal hormone therapy and risk of venous thromboembolism: what about progesterone?
The UK study by Vinogradova and colleagues provides further evidence that oral but not transdermal oestrogen is associated with increased risk of venous thromboembolism among women who use
Pharmacotherapeutic options for the treatment of menopausal symptoms
TLDR
The pharmacokinetics and pharmacodynamics of hormonal (androgens, estrogens, progestogens, tibolone, TSEC, SERMs) and non-hormonal treatments for menopausal symptoms are described and essential clinical trial data in humans is reported.
Update on Menopausal Hormone Therapy for Fracture Prevention
TLDR
Menopausal hormone therapy should be considered in women with premature estrogen deficiency and increased risk of bone loss and osteoporotic fractures, but use is hindered by increase in breast cancer risk even in women younger than 60 years old or who are within 10 years of menopause onset.
Cardiovascular Risk/Benefit Profile of MHT
TLDR
Timing of MHT initiation was shown to be a critical factor in CV risk assessment and CV risk calculation should be considered by clinicians in order to exclude patients with high CV risk, in whom MHT is contraindicated.
Progesterone Is Important for Transgender Women’s Therapy—Applying Evidence for the Benefits of Progesterone in Ciswomen
  • J. Prior
  • Medicine, Biology
    The Journal of clinical endocrinology and metabolism
  • 2019
TLDR
Accumulated evidence indicates that normally ovulatory menstrual cycles are necessary for ciswomen's current fertility, as well as for later-life bone and cardiovascular health and the prevention of breast and endometrial cancers, and transgender women deserve progesterone therapy and similar potential physiological benefits.
Effects of oral contraceptives on thyroid function and vice versa
TLDR
How hormonal OCs, including estrogen- or progesterone-only containing medications, interact with the hepatic production of thyroid-binding globulin (TBG) and, consequently, their effects on serum levels of thyroxine and triiodothyronine are reviewed.
Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice.
TLDR
HT is an effective treatment for bothersome menopausal vasomotor symptoms, genitourinary syndrome, and prevention of osteoporotic fractures and can improve bothersome symptoms, all the while conferring offset benefits such as cardiovascular risk reduction and a reduction in bone fracture risk.
The pharmacodynamics and safety of progesterone.
  • P. Piette
  • Biology, Medicine
    Best practice & research. Clinical obstetrics & gynaecology
  • 2020
Menopause hormone therapy, migraines, and thromboembolism.
...
...

References

SHOWING 1-10 OF 43 REFERENCES
Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women
TLDR
Transdermal estrogens may improve substantially the benefit/risk ratio of postmenopausal hormone therapy and should be considered as a safer option, especially for women at high risk for VTE.
Hormone Therapy and Venous Thromboembolism Among Postmenopausal Women: Impact of the Route of Estrogen Administration and Progestogens: The ESTHER Study
TLDR
Oral but not transdermal estrogen is associated with an increased VTE risk, and data suggest that norpregnane derivatives may be thrombogenic, whereas micronized progesterone and pregnane derivatives appear safe with respect toThrombotic risk.
Postmenopausal Hormone Therapy and Risk of Idiopathic Venous Thromboembolism: Results From the E3N Cohort Study
TLDR
Oral estrogen therapy increases venous thromboembolism risk among postmenopausal women using hormone therapy and route of estrogen administration and concomitant progestogens type are 2 important determinants of thrombotic risk.
Hormone therapy and venous thromboembolism among postmenopausal women.
  • P. Scarabin
  • Medicine, Biology
    Frontiers of hormone research
  • 2014
TLDR
Based on the current data, transdermal estrogen alone or combined with progesterone could be the safer HT especially in women at high risk for thrombosis.
Hormones and venous thromboembolism among postmenopausal women
  • P. Scarabin
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2014
TLDR
There is strong evidence that VTE risk is greater in women using medroxyprogesterone acetate compared with those receiving other progestins, and progesterone appears safe with respect to VTE.
Estrogen and progestogen effect on venous thromboembolism in menopausal women
  • D. Archer, E. Oger
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2012
TLDR
Oral hormone therapy has been used principally for management of menopausal symptoms and transdermal estrogens have not been used as extensively in the United States but have a significant use in Europe.
Prothrombotic Mutations, Hormone Therapy, and Venous Thromboembolism Among Postmenopausal Women: Impact of the Route of Estrogen Administration
TLDR
In contrast to oral estrogen, transdermal estrogen does not confer additional risk on women who carry a prothrombotic mutation, and the safety of transDermal estrogen has to be confirmed in randomized trials.
Hormone therapy and recurrence of venous thromboembolism among postmenopausal women
TLDR
Oral but not transdermal estrogens are associated with a higher risk of recurrent VTE among postmenopausal women, providing further epidemiological evidence that transder mal estrogens may be safe with respect to VTE risk.
Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study
TLDR
In contrast to oral estrogen, transdermal estrogen does not confer an additional risk of idiopathic VTE in women with increased BMI, and the safety of transDermal estrogen on thrombotic risk has to be confirmed.
...
...