Topical HRT and pulmonary embolism

[LarkDescending]

I have recently had 2 pulmonary emboli, believed to have been provoked by Covid or the combination of Covid and HRT. Unfortunately but unsurprisingly I have therefore been required to discontinue my systemic HRT (for now at least). I was on estradot 50 patches.

I want to look into topical HRT, both to help with general urogenital symptoms and also to make a forthcoming smear bearable. My GP doesn’t want to contemplate my having any sort of HRT for the foreseeable future unless a consultant signs off on the risk.

Does anyone have any experience of clinicians being willing to prescribe topical HRT to someone with recent thromboembolism, either long-term or (for the smear) short-term? Is it safe? I have seen some studies suggesting it is, but drug manufacturers still seem to warn against it.

I believe that all expert meno consultants would prescribe you Ovestin or Vagifem AND probably transdermal systemic estrogen (HRT) as well.

If you use Ovestin 2 x a week for a year it is equivalent to ONE daily dose of estrogen ( ie 1 mgs.) So the dose is tiny and hardly any is absorbed into the system.

The other thing is that transdermal estrogen as in a patch or gel does not cause blood clots. In fact all the research shows it's protective, by increasing blood flow and elasticity of arteries. If you had clots, you would have had them anyway regardless of HRT.

It's only with pill form that there is a slight risk of clots.

The other thing is it is now known to be dangerous to stop HRT abruptly- it can cause a rebound effect with cardio vascular stuff, so the guidance is to come off it very slowly by reducing the dose over 3 -6 months.

You need to see an expert because GPs aren't qualified to deal with this.

Thank you - yes my haematologist has referred me to a gynae specialising in this area so I look forward to discussing all of this with her.

Regarding the sudden stopping of HRT - I was required to take my patch off there & then in hospital. The first week of withdrawal was horrendous, with drenching sweats day and night, and I felt very unwell (I suppose I was very unwell in various ways). Too late to change that now but it felt very wrong. I also fear for my osteopenic bones. Ah well.

Actually I am now cross that I was required to stop my HRT suddenly or indeed at all. It was beneficial to me in so many ways.

If you se estradot, is that all you use? No progesterone?

Personally, I'd slap on the patch again.

The medical advice on transdermal is 'transdermal estrogen does not raise the risk of blood clots above the woman' baseline risk' .

This is all in the NICE guidance pinned at top of this forum.

You also need to be sure that the gynae you are waiting to see is a menopause/ HRT expert- not all gynaes are and they all have their own areas of expertise.

If you want to short circuit that there are at least two excellent UK meno experts doing Zoom consultations, at the moment, obviously for a fee.

Yes, just estradot as I have had a hysterectomy. I may well slap on a patch.

I have just looked at my referral letter and it’s in fact a male gynae (I was mistaken). His hospital profile says that he is certified as a Menopause Specialist by the British Menopause Society.

Many thanks for the help.

I have had a blood clot and a hysterectomy, and I am on oestrogen (estradiol) patches, after discussion with my gynae, @LarkDescending.

Do you have a good supply, because I am on Estraderm now and I need to find a good home for 2-3 boxes of Estradot 75. I'm happy to cover the postage. Expiry dates end of Oct 20, March 21, and March 21.

I feel strongly that women should have free and properly informed access to HRT.

@JinglingHellsBells certainly knows more than my GP.

@JamieLeeCurtains thank you. I will PM you.

You're welcome.