Obesity and venous thromboembolism

Abstract Obesity has significant and wide-reaching implications for all aspects of health care, and gynecology is no exception. Obesity is an independent risk factor for venous thromboembolism (VTE) and exerts a synergistic effect when combined with other VTE risk factors. This increased VTE risk is relevant when exposure to exogenous estrogen is being considered, for example, with combined hormonal contraception and/or hormone replacement therapy (HRT). Progesterone-only methods of contraception and intrauterine devices are associated with a low VTE risk and are generally preferred to combined hormonal methods in obese women. As regards HRT, the VTE risk varies according to the mode of administration of estrogen. Data suggest that patients using transdermal preparations of HRT have a lower risk of VTE compared with those on an oral preparation. As the use of transdermal estrogen does not appear to confer an increased risk of VTE, this would appear to be a safer option in obese menopausal women who require HRT. The increased VTE risk conferred by obesity is also relevant for assisted reproductive therapy (ART). ART is itself associated with an increased VTE risk, and it is conceivable that obesity would further increase this risk. Furthermore, obesity increases the risk of VTE following gynecological surgery and that associated with gynecological cancer. As the prevalence of obesity continues to rise, the associated VTE risk will become increasingly relevant.