Menopause and risk of thromboembolic events. CNGOF and GEMVi clinical practice guidelines

The incidence of venous thromboembolism (VTE) increases with age with an annual incidence of 1.25/1 000 women in the 40-59 age group. Menopausal hormone therapy (MHT) may also increases the risk of VTE. This risk must be assessed during the first consultation before initiating a MHT and assess each renewal of the MHT. MHT with oral estrogen combined (or not) with progestin increases the risk of VTE by about 70 %. Using transdermal estrogen does not appear to increase the risk of VTE in women. VTE risk appears to be modulated by the type of progestin combined in MHT. The risk of VTE associated with MHT with transdermal estradiol appears to be safe in micronized progesterone and pregnane derivatives women users and higher in norpregnane derivatives women users. To limit the risk of VTE associated with MHT, transdermal estradiol use is recommended. In women at risk of VTE, MHT with oral estrogen is contraindicated. MHT with transdermal estradiol associated (or not) with micronized progesterone or dydrogesterone may be used in women with low or moderate risk of VTE.