Managing thromboembolic risk with menopausal hormone therapy and hormonal contraception in the COVID-19 pandemic: Recommendations from the Spanish Menopause Society, Sociedad Española de Ginecología y Obstetricia and Sociedad Española de Trombosis y Hemostasia

Highlights

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  Peri- or postmenopausal patients with COVID-19 and in intensive care or at high risk should cease systemic menopausal hormone therapy and take low molecular weight heparins.

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  Peri- or postmenopausal patients with COVID-19 and at low risk should be switched to transdermal menopausal hormone therapy with low molecular weight heparins.

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  Perimenopausal patients with COVID-19 and in intensive care or at high risk should stop combined hormonal contraception and take low molecular weight heparins.

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  Low-risk perimenopausal patients with COVID-19 and using combined hormonal contraception should switch to progestogen-only contraception and take low molecular weight heparins.

Abstract

COVID-19 is associated with a systemic inflammatory response with activation of coagulation in symptomatic patients. The possibility of coagulopathies in peri- and postmenopausal women taking estrogen therapies makes it necessary to consider antithrombotic strategies, such as the use of low molecular weight heparins (LMWH) at specific prophylactic or treatment doses for each individual case, depending on the risk factors that each woman presents.

For such reasons, a panel of experts from various Spanish scientific societies has met to develop usage recommendations for managing menopausal women taking menopausal hormone therapy (MHT) or combined hormonal contraception (CHC) during the COVID-19 pandemic.