Question 81
Doctor N,
I have been advised against HRT after a complete hysterectomy due to a previous problem several years ago with DVT. Is there a chance that this form of HRT might be OK for me to use?
Reply:
It is a bit of a problem.
My belief is that using HRT for someone like yourself and its quality of life and health maintenance potential far outweigh any possible risk of DVT. This assumes that the patient uses a non oral approach, such as subcutaneous implants, or a patch, which does not alter the liver production of clotting factors as oral estrogen would. Most of the time, the biggest obstacle is the patient's physician is concerned about the possibility of a lawsuit, if the patient has a serious DVT related problem in the future. I have spoken to patients who have had episodes of DVT which were obviously not hormonally related who had considerable difficulty in getting their physicians to prescribe HRT, including some who solved the problem by finding a new physician in a different area and simply not telling him/her that they had a previous problem. I have treated patients with similar histories and have documented the patients desire to take HRT in the record and had the patient write a letter signed by herself and her husband outlining that they understood the possible risks, but wanted the therapy. What I told them is that I couldn't guarantee they wouldn't have another episode of DVT, but if they were using a non oral therapy such as subcutaneous implants, or a patch, that I did not believe it would be related to the therapy. For example, if a woman is using subcutaneous implants, or a patch, and is receiving estradiol, the identical hormone that is produced by the ovary and it is delivered into the blood physiologically avoiding the first liver pass, this should not be any more likely to induce a clot than the woman's own ovarian hormones. And, no one suggests that women with functioning ovaries who have had a DVT should have their ovaries removed.
Let me know if this is of any help.
Dr N