Ryzyko choroby zatorowo-zakrzepowej zwi zane z terapi hormonaln okresu oko omenopauzalnego

Decision on implementing hormone therapy in perimenopausal woman has to be based on analysis of potentialrisks and benefits of such treatment. Although rarely observed, one of the most serious complication ofhormonal therapy is thromboembolic disease. Many published clinical trials: Women’s Health Initiative (WHI),Heart and Estrogen/Progestin Replacement Study (HERS), Heart and Estrogen/progestin Replacement Studyfollow-up (HERS II), Estrogen in Venous Thromboembolism Trial (EVTET), Women’s International Study of longDuration Oestrogen after Menopause (WISDOM) showed a 2- to 3- fold increased risk of thromboembolismin women taking oral hormonal therapy. In practical terms, eight additional thromboembolic events would beexpected in every 10.000 women of normal weight, aged 50-59 years, taking combined estrogen-progestogenhormonal therapy for 12 months. The risk of thromboembolism is mainly associated with metabolic effects of estrogensbut new data show possible procoagulating activity of some progestogens. The risk appears to be moreprominent in women who start oral hormonal therapy (during first six months of treatment) and is increasedduring first 2 years of treatment. Transdermal delivery of estrogens appears to be a safer way of hormonal treatmentand is not associated with increased risk of thromboembolism. Several studies confirm that also syntheticsteroid, tibolone may diminish the risk of venous thrombosis. Nevertheless, transdermal 17β-estradiol, due toits safe profile, should be recommended as the drug of choice for majority of women during perimenopause.