Baldwin Maureen K, Samuelson Bannow Bethany, Rosovsky Rachel P, Sokkary Nancy, Srivaths Lakshmi V
Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA.
Oregon Health & Science University, Portland, Oregon, USA.
Res Pract Thromb Haemost. 2023 Apr 24;7(4):100161. doi: 10.1016/j.rpth.2023.100161. eCollection 2023 May.
There is widespread use of gonadal steroid hormone therapy for a variety of indications throughout the reproductive and postreproductive lifespan. These therapies may have particular benefits and specific risk among those with blood disorders, including inherited or acquired bleeding disorders, thrombophilia, thrombosis, or anemia. This clinical review is intended to provide a guidance for counseling and management of adolescent and adult biologic females with thrombophilic risk factors and/or thrombosis who require hormonal therapy. In general, synthetic estrogens present in contraceptive products should be avoided in those with a personal or strong family history of thrombosis or thrombophilias. In contrast, natural estrogens present in formulations for climacteric symptom management do not need to be avoided, and vaginal or transdermal formulations are preferred. Likewise, transdermal estradiol is preferred for gender-affirming hormone therapy and requires individualized assessment in those at high risk of thrombosis. Progestogens (either synthetic progestins or naturally occurring progesterone) can be used safely in nearly all patients. There is minimal safety evidence among anticoagulated patients at risk for thrombosis, which requires a patient-specific approach when discussing hormone therapies.
在整个生殖期和生殖后期，性腺甾体激素疗法因各种适应症而被广泛使用。这些疗法在患有血液疾病的人群中可能具有特殊益处和特定风险，这些血液疾病包括遗传性或获得性出血性疾病、易栓症、血栓形成或贫血。本临床综述旨在为需要激素治疗的、具有易栓症风险因素和/或血栓形成的青春期及成年生物学女性的咨询和管理提供指导。一般而言，有个人或强烈家族性血栓形成或易栓症病史的患者应避免使用避孕药产品中含有的合成雌激素。相比之下，用于更年期症状管理的制剂中含有的天然雌激素无需避免，阴道或透皮制剂更佳。同样，透皮雌二醇更适合用于性别确认激素治疗，对于血栓形成高危患者需要进行个体化评估。孕激素（合成孕激素或天然存在的孕酮）几乎可以在所有患者中安全使用。在有血栓形成风险的抗凝患者中，安全性证据极少，在讨论激素疗法时需要采取针对患者个体的方法。
