HRT and DVT

[JenaWren]

I'm actually post menopausal (LMP 6 years ago) and never considered HRT but I've got some things going on where I think it might be helpful.

I'm within the recommended window (under 60 and less than 10 years since LMP).

I spoke to my GP who wasn't very helpful - she's largely concerned that I have had recent DVT (provoked as a result of breaking my pelvis). She has booked me into see another GP who specialises in menopause in 3 weeks.

Has anyone had HRT with a history of DVT? What should I be looking out for and what questions should I ask?

@autumncrow I think you might have some experience?

@jinglingspringbells you were super helpful with my recent osteoporosis diagnosis and I think suggested that this might be a better option than the Alendronate they've put me on.

It's a tricky one. A recent DVT is usually considered a bit of a risk BUT the use of transdermal patches won't increase your risk of DVT more than it is already (this is in all the medical advice online.)

BUT your DVT was a result (?) of surgery or a fracture, so it doesn't sound as if you have a medical history or risk of blood clots.

Was the clot a result of surgery / impaired circulation after the fracture?
That isn't the same as someone who has a clot out of the blue.

The British Menopause Society does say that for women under 60, HRT should be considered as treatment for bone loss, and it is licensed for this.

This may be useful -

https://www.balance-menopause.com/menopause-library/can-i-take-hrt-if-i-have-a-risk-of-a-blood-clot/

I have had a couple of clots in my lower leg. One was superficial after a long haul flight, the other was a DVT after a knee surgery. So both provoked - investigated and no underlying blood conditions.

Advice I was given (by the clot clinic) was that I couldn't take oral HRT but stuff you apply to your skin was fine. I'm on 4 pumps of Oestrogen a day, plus a pessary.

That is so helpful. Thank you all - mumsnet is bloody brilliant!

My DVT is definitely provoked. Missed pelvic fracture (it wasn't diagnosed for 3 weeks) compounded by taking a flight to Barcelona the week after my accident.

In my defence A&E had told me there was no fracture and I should go Barcelona. In hindsight that was not a good idea.

That's useful to know about the clot clinic. I haven't actually been seen by them (despite being on anti coagulants for over 3 months).

Are there blood tests they can do to check if I have an increased risk of further clots? That would be very helpful.

Yes there are - I think I only had them because there was a history of a couple of clots, and the post-flight one was a bit suspicious. Plus I was still having pain after a couple of months. But I had them done privately - i had the appointment, blood tests and results, a few weeks before the NHS clot clinic called with their first appointment. They were amazing when I did speak to them though. I don’t know whether they would have done any blood tests, given it was a provoked clot though. But yes there are a raft of blood tests they can do which show any clotting conditions.

Thanks dgirl that's super helpful to know.

Just updating this for anyone who might find it helpful.

Saw the menopause specialist GP who was AMAZING. She really took her time and explained things properly.

She's prescribed transdermal oestrogen and progesterone which I can take with my provoked blood clot history. It will help my osteoporosis and protect against heart disease.

I feel so much better.

Thank you all for your advice and support.

One more question if I may.

@dgirluk are you on Utrogestan (micronised progesterone)?

My doctor (and some online reading) suggest no increase risk of blood clot. But the patient info leaflet says not to take if you have had a DVT.

No, I've got a Mirena fitted, so no need for additional progesterone.

Thanks dgirluk. Your advice had been brilliant.