Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women

@article{Oli2010RiskOV,
  title={Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women},
  author={Val{\'e}rie Oli{\'e} and Marianne Canonico and Pierre-Yves Scarabin},
  journal={Current Opinion in Hematology},
  year={2010},
  volume={17},
  pages={457–463}
}
Purpose of reviewVenous thromboembolism (VTE) is a main harmful effect of oral estrogen therapy among postmenopausal women. Transdermal estrogens may be safer but early results need to be confirmed. This review provides a summary of the most recent findings regarding the VTE risk among oral versus transdermal estrogens users. Recent findingsSince 2008, we identified five relevant observational studies. Among them, two large cohort studies confirmed that oral but not transdermal estrogens were… 
Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis
  • P. Scarabin
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2018
TLDR
Clinical findings emphasize the safety advantage of transdermal estrogen combined with progesterone and support the current evidence-based recommendations on HT, especially in women at high VTE risk.
Oral vs Transdermal Estrogen Therapy and Vascular Events: A Systematic Review and Meta-Analysis.
TLDR
Observational evidence warranting low confidence suggests that compared to transdermal ET, oral ET may be associated with increased risk of VTE and DVT, but not MI.
Hormone therapy and risk of venous thromboembolism among postmenopausal women.
TLDR
Transdermal estrogens alone or combined with micronized progesterone may represent the safest alternative for women who require postmenopausal hormone therapy.
Progestogens and venous thromboembolism among postmenopausal women using hormone therapy.
TLDR
Progestogens may have differential effects on VTE risk according to the molecules and therefore represent an important potential determinant of the thrombotic risk among postmenopausal women using estrogens.
Postmenopausal hormone therapy and venous thromboembolism.
TLDR
The route of estrogen administration, the type of concomitant progestogens and the dose of estrogens are three important determinants of the thrombotic risk among postmenopausal women using HT.
Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis.
TLDR
VTE risk was increased in postmenopausal women with no previous thromboembolic events using oral HT, and further clinical trials are needed to sort out the impact of different types of progestin and different estrogen doses and administration routes on VTE risk.
Hormone therapy and risk of venous thromboembolism among postmenopausal women
TLDR
Individual assessment of the benefit–risk ratio is needed before initiating treatment and oral estrogens should be avoided among women at high risk for venous thromboembolism, but norpregnane derivatives might be thrombogenic.
Oral versus transdermal estrogens and venous thromboembolism in postmenopausal women: what is new since 2003?
TLDR
A recent meta-analysis has confirmed the advantage of transdermal versus oral estrogens regarding VTE risk, despite divergences in rating the quality of evidence in this issue of Menopause.
Venous thromboembolism and cardiovascular disease complications in menopausal women using transdermal versus oral estrogen therapy
TLDR
This large matched-cohort study based on real-world data suggests that women receiving transdermal ET have significantly lower incidences of CVD events compared with those receiving oral ET, and that they also incur lower healthcare costs.
EMAS position statement: Managing menopausal women with a personal or family history of VTE.
TLDR
Observational studies suggest that micronized progesterone and dydrogesterone might have a better risk profile than other progestins with regard to VTE risk and strongly suggest that both the route of estrogen administration and the type of progestin may be important determinants of the overall benefit-risk profile of HT.
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References

SHOWING 1-10 OF 49 REFERENCES
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.
Postmenopausal Hormone Therapy and Risk of Idiopathic Venous Thromboembolism Results From the E 3 N Cohort Study
Objective—Oral estrogen therapy increases venous thromboembolism risk among postmenopausal women. Although recent data showed transdermal estrogens may be safe with respect to thrombotic risk, the
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.
Hormone replacement therapy and the risk of venous thromboembolism: a population‐based study
TLDR
Transdermal HRT and tibolone were not associated with an increased risk of venous thromboembolism in postmenopausal women and the risks with oral formulations were particularly elevated during the first year of use but disappeared 4 months after discontinuation.
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.
Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk
TLDR
Oral but not transdermal ERT is associated with risk of VTE in postmenopausal women, and data suggest that transder mal ERT might be safer than oral ERT with respect to thrombotic risk.
Venous thrombosis and conjugated equine estrogen in women without a uterus.
TLDR
An early increased VT risk is associated with use of estrogen, especially within the first 2 years, but this risk increase is less than that for estrogen plus progestin.
Activated protein C resistance among postmenopausal women using transdermal estrogens: importance of progestogen
TLDR
Transdermal estrogens combined with norpregnanes may induce APC resistance and activate blood coagulation and provide a biological support to epidemiological data regarding the potential thrombogenic effects of norPregnanes.
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.
Could transdermal estradiol + progesterone be a safer postmenopausal HRT? A review.
TLDR
While all types of hormone replacement therapies are safe and effective and confer significant benefits in the long-term when initiated in young postmenopausal women, in specific clinical settings the choice of the transdermal route of administration of estrogens and the use of natural progesterone might offer significant benefits and added safety.
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