Oral oestrogen passes through the liver first and raises clotting factors; transdermal oestradiol, given by patch or gel, largely avoids that effect. For this reason guidelines advise transdermal oestradiol for women who need hormone therapy and have raised venous thromboembolism risk, such as obesity or a history of clotting in the family.
When starting hormone therapy, choose the route as deliberately as the drug. Combine with a progestogen in any woman with a uterus, and use the lowest dose that controls symptoms.
- Prefer transdermal oestradiol when a woman has risk factors for venous thromboembolism
- Add a progestogen whenever the uterus is present
- Ask about personal and family history of clots before prescribing
- Review the need for therapy and the dose at least yearly
Why it matters
It turns a first-line recommendation into one that can be used safely in more women.
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