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Combined Oral Contraceptive Pill (COCP)/HRT

Personal and family clinical history is key to identify women at risk of VTE. Unselected testing for heritable thrombophilia will provide an uncertain estimate of risk and is not warranted.

The absolute risk for VTE in previously asymptomatic women with FV Leiden or PGV using COCP or HRT is not high.

There is a substantial risk for VTE in women with AT, PC or PS deficiency, FV Leiden homozygosity, PGV homozygosity, or combined thrombophilia defects in association with COCP or HRT use. In these cases COCP or HRT use is contraindicated.

The baseline risk for VTE in women using HRT is higher than in women using COCP because the HRT-user population is older with a higher age-related risk for VTE.

Testing for heritable thrombophilia in selected cases may assist counselling of women considering COCP or HRT, for example if a high-risk thrombophilia has been identified in a symptomatic relative.

Irrespective of the presence or absence of a detected heritable thrombophilia, a personal history of VTE is a contraindication to COCP or oral HRT. The use of COCP by women with a family history of VTE in a first-degree relative aged under 45 years is not recommended. A family history of VTE in a first-degree relative is a relative contraindication to HRT.