Menopause, Estrogen and Venous Events

The Menopause, Estrogen and Venous Events (MEVE) study was a retrospective observational study of menopausal hormone therapy and venous thromboembolism (VTE) in postmenopausal women with a previous history of VTE.[1][2][3][4][5] It found that transdermal estradiol was not associated with increased risk of VTE (HR = 1.0, 95% CI 0.4–2.4) whereas oral estrogens were associated with a large increase in risk (HR = 6.4, 95% CI 1.5–27.3).[1][3][4] The mean dose of transdermal estradiol in the study was 50 μg/day, although data on dose were missing for around 50% of women.[1][2] Similarly, a small study found that transdermal estradiol did not influence coagulation in women with prior VTE.[6] These findings are similar to studies in menopausal women without prior history of VTE which have found that transdermal estradiol has minimal influence on coagulation[7] and is not associated with increased risk of VTE at doses of up to 100 μg/day.[8][9][10][11] Menopausal hormone therapy guidelines have cited the MEVE study and recommended use of transdermal estradiol over oral estrogens in women at high risk for VTE.[12][13][14][15] However, randomized controlled trials (RCTs) are still needed to definitively confirm findings that transdermal estradiol is safer than oral estrogens in terms of VTE risk.[12][16][17]

## See also

* Estrogen in Venous Thromboembolism Trial (EVTET)
* List of notable clinical studies of menopausal hormone therapy

## References

1. ↑ 1.0 1.1 1.2 "Hormone therapy and recurrence of venous thromboembolism among postmenopausal women". Menopause 18 (5): 488–93. May 2011. doi:10.1097/gme.0b013e3181f9f7c3. PMID 21178641.
2. ↑ 2.0 2.1 "Risk of venous thromboembolism by route of administration of estrogen". Menopause 18 (5): 469–70. May 2011. doi:10.1097/gme.0b013e318211745b. PMID 21407136.
3. ↑ 3.0 3.1 "Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women". Curr Opin Hematol 17 (5): 457–63. September 2010. doi:10.1097/MOH.0b013e32833c07bc. PMID 20601871.
4. ↑ 4.0 4.1 "Hormone therapy and venous thromboembolism among postmenopausal women". Front Horm Res. Frontiers of Hormone Research 43: 21–32. 2014. doi:10.1159/000360554. ISBN 978-3-318-02673-3. PMID 24943295.
5. ↑ "What if the Women's Health Initiative had used transdermal estradiol and oral progesterone instead?". Menopause 21 (7): 769–83. July 2014. doi:10.1097/GME.0000000000000169. PMID 24398406.
6. ↑ "Transdermal estrogen therapy effects on fibrinogen levels in women with a past history of venous thromboembolism: a pilot study". Clin Exp Obstet Gynecol 38 (3): 232–5. 2011. PMID 21995153. https://ceog.imrpress.com/EN/article/downloadArticleFile.do?attachType=PDF&id=6843.
7. ↑ "Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review". Fertil Steril 90 (3): 642–72. September 2008. doi:10.1016/j.fertnstert.2007.07.1298. PMID 17923128.
8. ↑ "Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis". Thromb Res 168: 83–95. August 2018. doi:10.1016/j.thromres.2018.06.014. PMID 29936403.
9. ↑ "Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis". Climacteric 21 (4): 341–345. August 2018. doi:10.1080/13697137.2018.1446931. PMID 29570359.
10. ↑ "The route of administration, timing, duration and dose of postmenopausal hormone therapy and cardiovascular outcomes in women: a systematic review". Hum Reprod Update 25 (2): 257–271. March 2019. doi:10.1093/humupd/dmy039. PMID 30508190.
11. ↑ "Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases". BMJ 364: k4810. January 2019. doi:10.1136/bmj.k4810. PMID 30626577.
12. ↑ 12.0 12.1 "Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 100 (11): 3975–4011. November 2015. doi:10.1210/jc.2015-2236. PMID 26444994.
13. ↑ "2016 IMS Recommendations on women's midlife health and menopause hormone therapy". Climacteric 19 (2): 109–50. April 2016. doi:10.3109/13697137.2015.1129166. PMID 26872610.
14. ↑ "EMAS position statement: Managing menopausal women with a personal or family history of VTE". Maturitas 69 (2): 195–8. June 2011. doi:10.1016/j.maturitas.2011.03.011. PMID 21489728.
15. ↑ "American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of menopause". Endocr Pract 17 Suppl 6: 1–25. 2011. doi:10.4158/ep.17.s6.1. PMID 22193047.
16. ↑ "American Association of Clinical Endocrinologists and American College of Endocrinology position statement on menopause–2017 update". Endocr Pract 23 (7): 869–880. July 2017. doi:10.4158/EP171828.PS. PMID 28703650.
17. ↑ The NAMS 2017 Hormone Therapy Position Statement Advisory Panel (July 2017). "The 2017 hormone therapy position statement of The North American Menopause Society". Menopause 24 (7): 728–753. doi:10.1097/GME.0000000000000921. PMID 28650869.

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*[HR]: hazard ratio
*[CI]: confidence interval