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Administration of either combined estrogen-progestin or estrogen-only therapy to postmenopausal women is associated with as much as fivefold excess risk for venous thromboembolism (VTE). Moreover, this risk increases with age and certain common preexisting conditions (e.g., obesity, immobility, fracture, underlying cardiovascular disease). Now, the American College of Obstetricians and Gynecologists has released a Committee Opinion on route of estrogen administration and VTE risk.
Most studies of postmenopausal estrogen therapy and risk for VTE have involved oral hormone administration. First-pass metabolism of oral estrogen in the liver is thought to cause prothrombotic and proinflammatory effects through the hepatic induction of substances…