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Selected estrogen compounds modify risks of vein clotting, a response to hormone replacement theraphy

PITTSBURGH, Pa. -- Hormone replacement therapy is prescribed in women for a number of reasons, including those undergoing menopause, partial or full hysterectomy, or amenorrhea. After menopause, conjugated estrogens, estradiol, or estrone sulfate are given to reduce pain during intercourse, limit blood vessel effects, and prevent loss of bone mass. After radical hysterectomy, conjugated estrogens are given for similar reasons. After menopause or partial hysterectomy, progestin is administered at the same time to offset an increased risk of endometrial cancer. In some amenorrheas, estrogen is given to restore menstrual cycle, and if therapy is unsuccessful, this may indicate the presence of pathology, for instance, pituitary tumor. Benefits for postmenopausal women include a lowered risk of heart attack (estrogen lowers LDL and raises HDL levels), and prevention of osteoporosis, since the rate of bone loss is directly linked to a drop in estrogen levels.

Background
Despite the obvious benefits of this treatment, there is controversy regarding its application. Clinical trials indicate that the risk of venous thromboembolism (clotting of the veins) is about two to three times higher among current users of oral hormone replacement therapy containing estradiol, conjugated equine estrogen, and selective estrogen receptor modulators (SERMs) than among women who are not using hormone replacement therapy. (Conjugated equine estrogen (Premarin) contains 50-65 percent estrone sodium sulfate and 20-35 percent sodium equilin sulfate. Raloxifene is a synthetic estrogenic compound approved for clinical use in humans for prevention of osteoporosis.)

Many factors contribute to venous thrombosis including changes in the veins themselves, decreases in blood flow and increases in coagulation of the blood. Estrogen replacement drugs are known to alter coagulation, but little is known about affects on veins.

Veins are composed on a cell lining ca
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Contact: Donna Krupa
krupaco1@aol.com
703-967-2751
American Physiological Society
18-Oct-2001


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