HRT : the transdermal route , a solution of overweight or clotting disorders ?

The transdermal route to deliver estrogen through hormone replacement therapy is an alternative in case of clotting disorders linked to a genetic mutation on a coagulation factor , suggested Dr. Pierre- Yves Scarabin , the one of the authors of the Esther study , told Reuters Health .
The doctor was speaking at a symposium organized under the 8th Day Paris endoscopy , surgery and gynecology, which took place at the Pasteur Institute in Paris .

Estrogen administered orally multiply by 3 the risk of venous thromboembolic disease , knowing that the longer the treatment , the greater the risk increases .

The Esther multicentre case / control , aims to assess the risk of thromboembolism Doppler (for phlebitis of the lower limbs ) and scanner ( for pulmonary embolism ) , with women aged 45 to 70 years .

"This study has already confirmed that the thromboembolic risk is multiplied by 3 HRT containing estrogen orally, while neutrality vis-à -vis the dominant risk for transdermal (patch or gel ) , " says Dr. Scarabin .

Why such a difference in risk between the administration of hormones way ?

" The estrogen orally undergo first -pass metabolism , which promotes the activation of coagulation factors by developing resistance to a protein involved in these mechanisms, activated protein C Usually , it deactivates the Factor V . coagulation. But when it no longer plays the role of inactivation of coagulation is too easier and can cause the formation of a blood within the venous circulation clot in lower limbs ( phlebitis ) , clot can also migrate into the pulmonary venous system , causing a pulmonary embolism , a complication that can be fatal , "says specialist Reuters Health .

In addition, he says , the presence of a coagulation factor changed due to a genetic mutation (as is the case of factor V Leiden ) multiplies by 4 the thromboembolic risk , this risk is multiplied by 25 in women carrying this anomaly and receiving oral estrogen , whereas no change was observed with the transdermal route .

It is therefore according to him, to confirm the interest and safety of transdermal among women at high risk of thromboembolism who have climacteric symptoms significant enough to justify the prescription of HRT , taking into account genetic susceptibility .

" To turn these requirements into recommendations for practice , it is essential to undertake controlled clinical trials versus placebo ( inactive substance). It is already clear that any genetic mutation Factor V Leiden is a cons - absolute contraindication to hormonal oral treatments . Moreover, some specialty such as exists at the Hotel Dieu in Paris centers support patients affected by this problem by administering transdermal estrogens and see the next regularly on terms of circulation and coagulation , "concludes Dr. Scarabin .