Management of Women on Hormonal Therapy or Contraception in Women Undergoing Surgery
Hormone therapy and use of combination hormonal contraceptives are associated with an increased risk of venous thromboembolism. Menopausal women taking oral estrogen plus progesterone therapy are twice as likely to experience a venous thromboembolic event compared to women not on hormone therapy. Venous thromboembolism and pulmonary embolism are serious complications of surgery causing significant morbidity and mortality. To date, no studies exist that show preoperative discontinuation of menopausal hormone therapy reduces venous thromboembolism, so this should not be routine practice.
Some studies show a small increase in postoperative venous thromboembolism in reproductive-aged oral combination hormonal contraceptive users. This risk is directly related to the estrogen dose in the pill and is four times higher than for nonusers. Patients using progesterone only contraception do not have a higher risk of venous thromboembolism.
It is not necessary to discontinue combination hormonal contraceptives prior to brief surgeries, including minor laparoscopic procedures, as they are associated with a low venous thromboembolism risk. When women of reproductive age undergo major surgical procedures, the risk of stopping an oral combination hormonal contraceptive to decrease the venous thromboembolism risk will need to be weighed against the risk of unintended pregnancy. It takes four to six weeks for procoagulant changes associated with oral combination hormonal contraceptives to return to baseline after their discontinuation. For women on oral combination hormonal contraceptives undergoing major surgery, perioperative venous thromboembolism prophylaxis with mechanical or pharmacologic methods, and rarely both, should be based on procedure type and duration, age of the patient, and venous thromboembolism risk factors.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 84: Prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol. 2016 Jan;127(1):166. Reaffirmed 2018
Clark-Pearson D, Abaid L. Prevention of venous thromboembolic events after gynecologic surgery. Obstet Gynecol. 2012 Jan;119(1):155-67. doi: 10.1097/AOG.0b013e31823d389e.
Initial approval September 2015; Revised March 2018; Reaffirmed May 2019; Revised May 2021; Minor revision November 2022
********** Notice Regarding Use ************
The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. (“SASGOG”) is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice.
This document is designed to aid practitioners in providing appropriate obstetric and gynecologic care. Recommendations are derived from major society guidelines and high-quality evidence when available, supplemented by the opinion of the author and editorial board when necessary. It should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. SASGOG reviews the articles regularly; however, its publications may not reflect the most recent evidence. While we make every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. SASGOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither SASGOG nor its respective officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.
Copyright 2022 The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. All rights reserved. No re-print, duplication or posting allowed without prior written consent.
Back to Search Results