OTHER DISORDERS OF HRT: WOMEN WITH HIGH BLOOD PRESSURE OR A HISTORY

Such women need more intensive surveillance than usual if they try HRT. In any case, it is a good idea for women on HRT to have their blood pressure checked regularly. If significant changes occur, it is important to have a full medical assessment and prompt treatment to control the problem (with blood pressure medications).

If you have a personal history of blood clots that developed for no apparent reason, or a family history of clotting disorders, you should tread cautiously where HRT is concerned. A thorough investigation of clotting function should be completed before deciding about whether or not to embark on hormone therapy. Genevieve developed a spontaneous clot in one leg during her thirties and, many years later, when she was contemplating HRT, a full investigation of her clotting factors was carried out. These revealed some minor abnormalities. However, Genevieve decided to start on a hormone patch to relieve her wide-ranging and severe menopausal symptoms. She asked her doctor about using aspirin to minimise the risk of further clot development, and was told that this was appropriate in her situation.

If clots are triggered by something definite like pregnancy, childbirth or previous surgery, HRT in patch form may be considered suitable. Some studies suggest that HRT does not significantly increase the risk of clots. But where there is any doubt it is wise to avoid taking the hormones in pill form, giving preference to patches. This is because the liver, which plays a major role in blood pressure control and blood clot formation, may become overactive when called on to handle the larger hormone load that occurs with pill formats (the patch releases hormones more gradually).