130035 - Case Study: Managing menopausal symptoms in women with a history of VTE

This is a case study of a patient seeking treatment for menopausal symptoms who has a history of fracture and venous thromboembolism (VTE).

Relevance to General Practice

The risk of VTE is low in most women. The use of oral menopausal hormone therapy doubles the woman’s baseline risk of VTE, however a woman’s overall or “absolute risk” will still be small at about two in 1,000 per year for women aged 50-59 years. Transdermal preparations of MHT have not been shown to increase risk of VTE in observational studies.
The perception of risk and the different VTE risk profiles of different MHT preparations is confusing for GPs. This case study highlights the importance of taking a detailed patient history to assess the patient’s risk of VTE recurrence when prescribing treatments for menopausal symptoms.

Learning outcomes

Calculate osteoporotic fracture risk using the Garvan Fracture Risk Assessment Tool

List factors to consider when assessing future risk of venous thromboembolism (VTE recurrence)

Describe suitable treatment options for menopausal symptoms in patients with a history of VTE