Menopausal hormone therapy and the risk of venous thromboembolic complications: a modern aspect of the problem
https://doi.org/10.51922/2616-633X.2022.6.2.1700
Abstract
Age-related aspects of women’s health have been in the focus of attention of cardiologists, gynecologists, and endocrinologists for many years. The physiological features of the course of the peri- and postmenopausal periods and the possible consequences of estrogen deficiency are already well-studied. For nearly 20 years, there has been a debate about the benefit-risk ratio of menopausal hormone therapy. The evidence for its protective effect on age-related cases is overwhelming: prevention of osteoporosis development, cardiovascular diseases, cognitive decline, and improvement of the overall quality of life. The article presents current data on the association of menopausal hormone therapy with venous thromboembolic complications, depending on the type of estrogen and progestogen components, dose, regimen and methods of application. The feasibility and safety of menopausal hormone therapy in the context of the COVID-19 coronavirus pandemic is considered. The probability of increased risk of thromboembolic complications in case of COVID-19 infection during menopausal hormone therapy has not been proven in clinical practice. The data from the latest publications are presented, indicating the likely positive effect of female sex hormones on the course of SARS-CoV-2 and the recommendations of the leading international communities on menopause measurement regarding the admissibility of menopausal hormone therapy during the pandemic and limited ability to counsel patients.
About the Authors
А. ZaharkoBelarus
Gomel
A. Podgornay
Belarus
Gomel
O. Murashko
Belarus
Gomel
References
1. Konstantinides S.V., Guy Meyer, Becattini C., Bueno H., Geersing G.J., Harjola V.P., Huisman M.V., Humbert M., Jennings C.S., Jimenez D., Kucher N., Lang I.M., Lankeit M., Lorusso R., Mazzolai L., Meneveau N., Ainle F.N., Prandoni P., Pruszczyk P., Righini M., Torbicki A., Van Belle E., Zamorano J.L. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J, 2019, vol. 40(42), pp. 3453-3455. doi: 10.1093/eurheartj/ehz726.
2. Balan V.E., Andreeva E.N., Yureneva S.V., Tkachyova O.N., Ilyuhin I.E. Risk i polza menopauzalnoj gormonalnoj terapii [Risk and benefits of menopausal hormonal therapy]. Akusherstvo i ginekologiya, 2020, vol. 3, pp. 33-41. (in Russian).
3. Adamyan L.V., Andreeva E.N., Absatarova Yu.S. Menopauzalnaya gormonalnaya terapiya v period pandemii: vzveshivaem polzu i riski [Menopausal hormone therapy during a pandemic: weighing the benefits and risks]. Problemy reprodukcii, 2021, vol. 27, no. 3-2, pp. 35-39. (in Russian).
4. Madyanov I.V., Madyanova T.S. Menopauzalnaya gormonalnaya terapiya pri osnovnyh endokrinnyh zabolevaniyah [Menopausal hormonal therapy in major endocrine diseases]. Prakticheskaya medicina, 2019, vol. 17, no. 4, pp. 118-122. (in Russian).
5. Podzolkov V.I., Bragina A.E., Podzolkova N.M. Menopauzalnaya gormonalnaya terapiya i serdechno-sosudistaya profilaktika: zhelaemoe ili dejstvitelnoe? [Menopausal hormone therapy and heart disease prevention: desired or valid?] Kardiovaskulyarnaya terapiya i profilaktika, 2019, Т. 18, № 3, С. 94-106. (in Russian).
6. Bińkowska M., Jakimiuk A., Paszkowski T., Pawelczyk L., Skrzypulec-Plinta V. Risk of venous thromboembolism during the use of oral estrogen-progestogen hormone therapies in light of most recent research findings. Prz Menopauzalny, 2022, vol. 21, № 3, pp. 197-199.
7. Kuznetsov M.R., Papysheva O.V. Menopauzalnaya gormonalnaya terapiya i venoznye tromboembolicheskie oslozhneniya: kakova vzaimosvyaz? [Menopausal hormonotherapy and venous thromboembolic events: is there any correlation?] Doktor.Ru, 2019, no. 11(166), pp. 68-73. (in Russian).
8. Baber R.J., Panay N., Fenton A.; IMS Writing Group NS 2016 IMS. Recommendations on women’s midlife health and menopause hormone therapy. Climacteric, 2016, vol. 19, № 2, pp. 109-150. doi: 10.3109/13697137.2015.1129166.
9. Stevenson J.C., Rozenberg S., Maffei S.3, Egarter C., Stute P., Römer T. Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference. Drugs Context, 2020, vol. 9, pp. 1-12. doi: 10.7573/dic.2020-10-1.
10. Yakushevskaya O.V., Yureneva S.V. Menopauzalnaya gormonalnaya terapiya v usloviyah pandemii koronavirusnoj infekcii COVID-19 [Menopausal hormonal therapy during COVID-19 pandemic]. Doktor.Ru, 2021, vol. 20, no. 1, pp. 78-83. (in Russian).
11. Vinogradova, Y., Coupland C., Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the Q Research and CPRD databases. BMJ, 2019, vol. 364, pp. k4810.
12. Pirógа, M., Jach R., Undas А. Effects of ultra-low-dose versus standard hormone therapy on fibrinolysis and thrombin generation in postmenopausal women. Eur J Obstet Gynecol Reprod Biol, 2017, vol. 217, pp. 77-82.
13. LaVasseur C., Neukam S., Kartika T., Bannow B.S., Shatzel J., DeLoughery T.G. Hormonal therapies and venous thrombosis: Considerations for prevention and management. Res Pract Thromb Haemost, 2022, vol. 23, №6(6), pp. e12763.
14. Tsai W.-C., Haung Y.-B., Kuo H.-F., Tang W.-H., Hsu P.-C., Su H.-M., Lin T.-H., Chu C.-S., Jhuo S.-J., Lee K.-T., Sheu S.-H., Chen C.-Y., Wu M.-T., Lai W.-T. Hormone replacement therapy and risk of atrial fibrillation in Taiwanese menopause women: A nationwide cohort study. Sci Rep, 2016, vol. 6, pp. 24132. doi: 10.1038/srep24132.
15. Canonico M., Oger E., Conard J., Meyer G., Lévesque H., Trillot N., Barrellier M T., Wahl D., Emmerich J., Scarabin P.Y.; Estrogen and THromboEmbolism Risk (ESTHER) Study Group. Obesity and risk of venous thromboembolism among postmenopausal women: differential impact of hormone therapy by route of estrogen administration. The ESTHER Study. J Thromb Haemost, 2006, vol. 4, no. 6, pp. 1259-65. doi: 10.1111/j.1538-7836.2006.01933.x.
16. Dinger J., Bardenheuer K., Heinemann K. Drospirenone plus estradiol and the risk of setious cardiovascular events in postmenopausal women. Climacteric, 2016, vol. 19, no. 4, pp. 349-356.
17. Panay N. et. al. Venous thromboembolism risk in menopausal women treated with oral estradiol/micronised progesterone versus conjugated estrogens/medroxyprogesterone: a claims data analysis in the United States. 20th ISGE World Congress, Florence, Italy, 11-14.05.2022.
18. Bińkowska M., Jakiel G, Paszkowski T., Skrzypulec-Plinta V., Zgliczyński W. Position statement by experts of the Polish Menopause and Andropause Society on menopausal hormone therapy with an oral combination drug containing oestradiol 1 mg and progesterone 100 mg. Prz Menopauzalny, 2021, vol. 20(3), pp. 113-115. doi: 10.5114/pm.2021.109887.
19. Lobo R.A., Kaunitz A.M., Santoro N., Bernick B., Graham S., Mirkin S. Metabolic and cardiovascular effects of TX-001HR in menopausal women with vasomotor symptoms. Climacteric, 2019, vol. 22(6), pp. 610-616.
20. Pertyńska-Marczewska, М., Pertyński T. Premenopausal and postmenopausal women during the COVID-19 pandemic. Prz Menopauzalny, 2022, vol. 21, no. 3, pp. 200-206. doi: 10.5114/pm.2022.118695.
21. Gersh М., Lavie .CJ., O’Keefe J.H. Menopause status and coronavirus disease (COVID-19). Clin Infect Dis, 2021, vol. 73(9), pp. e2825-e2826.
22. Breithaupt-Faloppa A.C., de Jesus Correia C., Prado C.M., Stilhano R.S., Ureshino R.P., Moreira L.F.P. 17α-Estradiol, a potential ally to alleviate SARS-CoV-2 infection. Clinics (Sao Paulo), 2020, vol. 75, pp. e1980. doi: 10.6061/clinics/2020/e1980.
23. Seeland U., Coluzzi F., Simmaco M., Mura C., Bourne P.E., Heiland M., Preissner R., Preissner S. Evidence for treatment with estradiol for women with SARS-CoV-2 infection. BMC Medicine, 2020, vol. 18(1), pp. 369.
24. ACOG. COVID-19 FAQs for Obstetrician-Gynecologists. Gynecology [electronic resource]. Available at: https://www.acog.org/clinical-information/physician-faqs/covid19- faqs-for-ob-gyns-gynecology. (accessed 29.05. 2021).
25. Cagnacci A., Bonaccorsi G., Gambacciani M.; board of the Italian Menopause Society. Reflections and recommendations on the COVID-19 pandemic: Should hormone therapy be discontinued? Maturitas, 2020, vol. 138, pp. 76-77.
26. Wang X.W., Hu H., Xu Z.-Y., Zhang G.-K., Yu Q.-H., Yang H.-L., Zheng J.-H. Association of menopausal status with COVID-19 outcomes: a propensity score matching analysis. Biol Sex Differ, 2021, vol. 12(1), pp. 16.
Review
For citations:
Zaharko А., Podgornay A., Murashko O. Menopausal hormone therapy and the risk of venous thromboembolic complications: a modern aspect of the problem. Emergency Cardiology and Cardiovascular Risks journal. 2022;6(2):1700-1706. (In Russ.) https://doi.org/10.51922/2616-633X.2022.6.2.1700