Sex hormones and venous thromboembolism – from contraception to hormone replacement therapy

Beyer‐Westendorf, Jan; Bauersachs, Rupert; Hach-Wunderle,; Rb, Zotz; Rott, Hannelore

doi:10.1024/0301-1526/a000726

Cited by 12 publications

(6 citation statements)

References 67 publications

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“…Preoperative sex steroid replacement was not agreed upon, even in symptomatic patients with hypogonadism. Some panelists raised concerns that sex steroid administration carries a prothrombotic risk, which may be even higher in the perioperative period (data not shown) [ 29 ]. There are no data suggesting a better surgical outcome if sex steroids are replaced preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas

et al. 2021

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Purpose In adults and children, transsphenoidal surgery (TSS) represents the cornerstone of management for most large or functioning sellar lesions with the exception of prolactinomas. Endocrine evaluation and management are an essential part of perioperative care. However, the details of endocrine assessment and care are not universally agreed upon. Methods To build consensus on the endocrine evaluation and management of adults undergoing TSS, a Delphi process was used. Thirty-five statements were developed by the Pituitary Society’s Education Committee. Fifty-five pituitary endocrinologists, all members of the Pituitary Society, were invited to participate in two Delphi rounds and rate their extent of agreement with statements pertaining to perioperative endocrine evaluation and management, using a Likert-type scale. Anonymized data on the proportion of panelists’ agreeing with each item were summarized. A list of items that achieved consensus, based on predefined criteria, was tabulated. Results Strong consensus (≥ 80% of panelists rating their agreement as 6–7 on a scale from 1 to 7) was achieved for 68.6% (24/35) items. If less strict agreement criteria were applied (ratings 5–7 on the Likert-type scale), consensus was achieved for 88% (31/35) items. Conclusions We achieved consensus on a large majority of items pertaining to perioperative endocrine evaluation and management using a Delphi process. This provides an international real-world clinical perspective from an expert group and facilitates a framework for future guideline development. Some of the items for which consensus was not reached, including the assessment of immediate postoperative remission in acromegaly or Cushing’s disease, represent areas where further research is needed.

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Section: Discussionmentioning

confidence: 99%

Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas

et al. 2021

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“…Transdermal HRT has the benefit of avoiding first pass liver metabolism and as such the effect on the coagulation cascade is much less. 23 Following the concern raised about the increased risk of VTE identified with HRT in the WHI study at the start of the century, further work was done into whether that effect was consistent across all forms of HRT. A retrospective study of women in France showed that the increased risk was associated with oral HRT and not transdermal HRT (OR, 3.5, 95% CI 1.8–6.8, vs. OR 0.9, 95% CI 0.5–1.6).…”

Section: Introductionmentioning

confidence: 99%

Hormone replacement therapy in women with history of thrombosis or a thrombophilia

Morris

Talaulikar

2022

Post Reprod Health

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Findings from the Women’s Health Initiative (WHI) randomised placebo-controlled trial (RCT) were published at the beginning of this century. They suggested that hormone replacement therapy (HRT) use increased the risk of cardiovascular disease and venous thromboembolism including pulmonary embolism and deep vein thrombosis The findings led to a decline in HRT prescriptions and negative publicity about the use of HRT for women with significant menopausal symptoms. Subsequent studies have shown that the risk of thrombosis with HRT relates to whether oestrogen is combined with a progestogen and the route of administration of oestrogen. In healthy women with no background medical problems, transdermal hormone replacement is not associated with an increased risk of thrombosis. However, much less is known about the safety of various HRT preparations in women with a high background risk of thrombosis. These cases can often be challenging for clinicians with uncertainties around testing for thrombophilia, use of anticoagulation and striking a balance between the risks and benefits of prescribing HRT. This article will review the mechanism of thrombosis with differing types of HRT and present the evidence from the relevant trials. The article will also present the evidence that specifically relates to women with a personal history of thrombosis or thrombophilia (heritable and acquired) to enable clinicians to better individualise the risk assessment for each woman requesting HRT and understand the role of thrombophilia screening or concomitant anticoagulation in such situations.

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“…18 Across the UK, women and the communities they live within are characterised by a wide range of diverse factors, such as ethnicity, occupation, health status, and level of education, 2,13,[19][20][21] which supports the need for personalised care. In addition to this, certain patient groups, for example, women with either chemically induced or surgical menopause, early menopause, or premature ovarian insufficiency [22][23][24] should receive enhanced menopause management for symptom control.…”

Section: Introductionmentioning

confidence: 99%

Consensus-led recommendations supporting choice and personalisation of Hormone replacement therapy in menopause care

Briggs

Barber²,

Cooke

et al. 2022

Post Reprod Health

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Objective Inequity of access and choice to different hormone replacement therapy (HRT) products across the UK has been suggested (Hillman, 2020). While, the cause is not entirely understood, potential contributors include conflicting national guidance, economic deprivation and a local formulary approach. With a diverse and growing population of women reaching and living well beyond the menopause, the impact of this inequity is becoming more pronounced, and challenges the goal of providing personalised care. The study objective is to establish a consensus that supports a greater equity of access and choice of HRT and provision of individualised care. Study Design Modified Delphi study designed by UK HCPs with expertise in menopause care. This group identified 40 consensus statements over four key topics, related to access and choice of different HRT products. An online 4-point Likert scale questionnaire, sent to UK HCPs, was used to assess agreement, with a consensus threshold set at 75%. Main Outcome Measures 150 HCP responses between June and September 2021 Results A total of 137 responses were received. Analysis identified 37/40 statements attaining very high agreement (≥ 90%) and 3/40 statements attaining high agreement (< 90% and ≥75%). Nine recommendations were developed with the intent to inform potential improvements to menopause care in the UK. Conclusions The high levels of agreement displayed suggest a desire to change the way menopause care is delivered in the UK. Implementation of the suggested recommendations has the potential to improve equity of access to licensed treatment options, compliant with the NICE recommendation for personalisation of care.

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Sex hormones and venous thromboembolism – from contraception to hormone replacement therapy

Cited by 12 publications

References 67 publications

Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas

Pituitary Society Delphi Survey: An international perspective on endocrine management of patients undergoing transsphenoidal surgery for pituitary adenomas

Hormone replacement therapy in women with history of thrombosis or a thrombophilia

Consensus-led recommendations supporting choice and personalisation of Hormone replacement therapy in menopause care

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