hormones & blood clots

I am 46 years old and have not had a period for 2 years.  Test show I am in menopause, early I guess. I have all the usual symptoms, hot flashes, belly fat, achy joints and muscles, less stamina, less sexual drive, foggy thought patterns, etc.  I would like hormone replacement to help me not age prematurely. The problem is that last year I had my appendix removed after peritiniss and recovery was inhibited by pulmonary edima and a dvt and pulmunary embolism. I was on cumadin (coumadin) for 6 months.  Now I am told that estrogen is out of the question because of the increased possiblity of clots.  A series of blood tests was performed to find if there was some reason for the blood clot and all came back normal except an elevated level of activated protein C was found with no lupis markers.  What does that mean?  Why would there be an elevated level?  From what I found activated protein C is produced to decrease clots.  Doesn't that mean I have less of a chance of forming them?  Wouldn't I be able to take estrogen then?

[Machelle Seibel, MD]

Whether or not to take estrogen can be challenging for women who have a history of a blood clot. Sometimes the infection/inflamation that happened after your appendix was removed can contribute to a clot. You might have been in pain and moved around very little which also contributed. Activated protein C is supposed to help prevent a clot. It can be elevated if there in an infection.

It is understandable that your doctors are concerned about you taking estrogen. The risk for another blood clot might be increased. Perhaps the best thing to do is to discuss your symptoms with your doctor and look for alternative approaches to each of them.  For instance, discuss alternatives to estrogen for hot flashes such as soy, black cohosh, relaxation techniques, progesterone, and gabapentin.
Do the same for your achy joints and muscles, reduced libido and foggy thoughts. Perhaps you are sleeping less well and need assistance with that.

Most importantly, talk with your doctor about how your symptoms are affecting your life. Discuss the risks and the benefits of estrogen and what risk you are willing to take. After trying alternatives to estrogen and seeing the level of improvement, you'll be able to decide together how much risk is reasonable for any symptoms that remain.
Machelle Seibel, MD