Systemic MHT in individuals at increased risk of venous thromboembolism

A past history of venous thromboembolism (VTE) or known thrombophilia is a contraindication to all forms of systemic menopausal hormone therapy (MHT) without specialist advice.

In individuals who have not had a previous VTE, risk of VTE is increased with oral estrogen, but not with transdermal estrogen (although data are limited regarding high-dose transdermal estrogen).

For individuals with risk factors for VTE (eg obesity, smoking, thrombophilia) who need systemic MHT, use a transdermal formulation and address VTE risk factors (see VTE prophylaxis).

Note: Individuals with an increased risk of VTE can use transdermal but not oral MHT. Systemic MHT in individuals with a past history of VTE requires specialist advice.

Limited data suggest risk may vary between progestogens; dydrogesterone and micronised progesterone may be safer than other progestogens, but no randomised controlled data are available to guide choice.