Individualisation of hormone replacement therapy

Abstract

Recent publications provide clear evidence linking HRT and VTE; with a relative risk of between 2 and 4 and an absolute risk of around 3 per 10,000 users per year. 6 The baseline risk in menopausal women is of the order of 1 in 10,000 per year. This means that for 10,000 women years of use, HRT would be responsible for two extra cases of VTE that would otherwise not have occurred. HRT affects some haemostatic parameters. 7 Women commencing HRT should be evaluated for VTE risk factors on an individual basis and advised not only of the potential benefits but also of the risk of venous thrombosis. When taking the history it is essential to assess the family history, the severity of any personal event and whether or not it was objectively confirmed. A personal history of VTE is the single biggest risk for a future episode, risk of recurrence being 5% per annum.