HRT and anaesthesia

Medical education has been slow to catch up with the menopause. I was taught nothing about the menopause at medical school and generations of women have suffered the insidious onset of a myriad of symptoms which has severely affected their quality of life for up to a decade. Fortunately this is changing. Phoenix Hospital Group now has several specialists running menopause clinics at 25 Harley Street, and the use of HRT is becoming more common.

There has been concern about an increased risk of deep vein thrombosis and pulmonary emboli (venous thromboembolism or VTE) to women taking HRT. One paper looked at over 80,000 women and concluded that there was no increased risk if the drugs were taken by patches or sprays, and only a limited increased risk in women taking oral oestrodiol, the most common preparation. You can read more about this paper at

With more women now taking HRT the question of whether they need to stop their drugs for surgery is becoming more common. The good news is that there is no evidence that HRT increases the risk of VTE in relation to surgery and anaesthesia. This applies to all HRT drugs and all routes. The Royal College of Anaesthetists, the Royal College of Obstetricians and Gynaecologists and NICE all state these drugs should be continued. Women on HRT need not worry an operation means they will have a recurrence of their symptoms and weeks of restabilising their treatment. Every patient having an operation is assessed for the risk of VTE and treated appropriately, but HRT is not part of that assessment. Hopefully this knowledge will avoid over prescription of heparin and the risk of bleeding after operations.