Case Conversation: Hormonal Therapies in Females with Blood Disorders

This is a recorded version of the journal club program, Case Conversation: Hormonal therapies in females with blood disorders: thrombophilia, thrombosis, hemoglobinopathies, and anemias, that was presented live on March 20, 2024.  Please scroll all the way down this page to view the archived program.

Webinar Date: 3/20/2024
Estimated Time to complete: 1 hour
Format: Archived Case Conversation (Journal Club)
Target Audience: 
This activity is designed for healthcare professionals, including hematologists, obstetricians, gynecologists, pediatric/adolescent gynecologists, advance practice providers, and nurses specializing in the care of women/girls are the primary target audience to ensure optimal comprehensive care.

Program Description:
In this clinical review, the authors summarize the benefits, risks, and considerations for use of a wide variety of hormonal therapy formulations among individuals with blood disorders, including inherited and acquired thrombophilia, thrombosis, hemoglobinopathies, and anemia. This guidance follows a previously published thorough review of the estimated risk of venous thrombosis in healthy users of specific gonadal steroid hormone products.

This case conversation will address the following learning objectives:

1. Describe the dosing and formulations of hormonal therapies
2. Discuss the estimates of thrombosis risk based on contraceptive and menopausal dosing
3. Review thrombosis risk with gender-affirming hormone therapy and menstrual management

Faculty

Maureen Baldwin, MD, MPH
Associate Professor of Ob/Gyn
OHSU, Portland, OR

Bethany Samuelson Bannow, MD, MCR
Associate Professor of Medicine
The Hemostasis and Thrombosis Center
OHSU, Portland, OR

Lakshmi Srivaths, MD (Moderator)
Professor of Pediatrics, Department of Pediatrics
UT Health McGovern Medical School
Gulf States Hemophilia & Thrombophilia Center
Houston, TX

1. Which route of hormonal administration is associated with the highest risk of VTE?
   Answer: Oral
2. For which high-risk medical condition is estrogen NOT contraindicated?
   Answer: Greater than 45 years of age
3. What does category 2 mean in the U.S. CDC Medical Eligibility Criteria?
   Answer: Use estrogen since benefit outweighs risks
4. How do synthetic estrogens potentiate thrombosis?
   Answer: Probably due to upregulation of hepatic enzymes
5. Which medical society suggests use of transdermal estrogen for their population, especially in high-risk health conditions?
   Answer: North American Menopause Society (NAMS)

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