Elsevier announced the publication of an important position statement from the European Menopause and Andropause Society (EMAS) in the journal Maturitas on managing menopausal women with a personal or family history of venous thromboembolism (VTE). The statement includes summary recommendations as a quick aid for the busy clinician.
“The expanding ageing female population means that clinicians increasingly have to deal with post-reproductive health problems,” said Professor Serge Rozenberg, President of EMAS. “EMAS has risen to the challenge and is providing clear guidance on the position statements covering hormone and non hormone therapy (HT) options, as well as complementary and alternative therapies.”
The statement will be published in the June 2011 issue:
Venous thromboembolism, including Deep venous thrombosis (DVT) and Pulmonary embolism (PE), is a serious cardiovascular event whose incidence rises with increasing age. Randomized controlled trials have shown an increased risk of VTE in oral hormone therapy (HT) users. There are no randomized trial data on the effect of transdermal estrogen on VTE. Recent observational studies and meta-analyses suggest that transdermal estrogen does not increase VTE risk. These clinical observations are supported by experimental data showing that transdermal estrogen has a minimal effect on hepatic metabolism of hemostatic proteins as the portal circulation is bypassed.
A personal or family history of VTE, especially in individuals with a prothrombotic mutation, is a strong contraindication to oral HT but transdermal estrogen can be considered after careful individual evaluation of the benefits and risks. Transdermal estrogen should be also the first choice in overweight/obese women requiring HT. Observational studies suggest that micronized progesterone and dydrogesterone might have a better risk profile than other progestins with regard to VTE risk.
Although these findings should be confirmed by randomized clinical trials, they 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.
About European Menopause and Andropause Society (EMAS)
The European Menopause and Andropause Society (EMAS) was founded to promote the study of all aspects of midlife health and beyond in both men and women and to advance the interchange of research and clinical experience between its members. EMAS also participates in international congresses related to the menopause and andropause. Through its activities, EMAS aims to guarantee and provide the same standard of education and information throughout Europe on postreproductive health in both genders. The statutes of EMAS have been submitted to and accepted by the Swiss Authorities and the Society is now acknowledged by the Swiss Government and the International Menopause Society as the official Regional European Menopause Society. EMAS also belongs to the Council of affiliated Menopause Societies (CAMS) of the International Menopause Society (IMS).
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Contact: Greyling Peoples