Obstet Gynecol. 2013 Apr;121(4):887-890. doi: 10.1097/01.AOG.0000428645.90795.d9.
The development of menopausal symptoms and related disorders, which lead women to seek prescriptions for postmenopausal estrogen therapy and hormone therapy, is a common reason for a patient to visit her gynecologist, but these therapies are associated with an increased risk of venous thromboembolism. The relative risk seems to be even greater if the treated population has preexisting risk factors for venous thromboembolism, such as obesity, immobilization, and fracture. Recent studies suggest that orally administered estrogen may exert a prothrombotic effect, whereas transdermally administered estrogen has little or no effect in elevating prothrombotic substances and may have beneficial effects on proinflammatory markers. When prescribing estrogen therapy, the gynecologist should take into consideration the possible thrombosis-sparing properties of transdermal forms of estrogen therapy. As part of the shared decision-making process, the gynecologist should weigh the risks against the benefits when prescribing combination estrogen plus progestin hormone therapy or estrogen therapy and counsel the patient accordingly.
绝经相关症状和疾病的发展，导致女性寻求绝经后雌激素治疗和激素治疗的处方，这是患者看妇科医生的常见原因，但这些治疗与静脉血栓栓塞风险增加相关。如果治疗人群存在静脉血栓栓塞的预先存在的风险因素，如肥胖、固定不动和骨折，相对风险似乎更大。最近的研究表明，口服雌激素可能具有促血栓形成作用，而经皮给予雌激素对升高促血栓形成物质几乎没有影响，并且可能对促炎标志物有有益影响。在开具雌激素治疗处方时，妇科医生应考虑经皮雌激素治疗形式可能具有的血栓预防特性。作为共同决策过程的一部分，妇科医生在开具雌孕激素联合激素治疗或雌激素治疗的处方时，应权衡利弊，并相应地为患者提供咨询。
