Hormone Replacement and Mommy Makeover?

Question

I am on prometrium (po)& vivelle patch for perimenopausal symptoms (for 2 years). I will be 49 at time of surgery (TT, BA, BL, and lipo)- scheduled 11/2011. Gyn last year wanted to start to taper me off of my hormones at the end of this year (2011). Should I talk w/my gyn about tapering earlier? What is the recommendation about hormone replacement and surgery - does it increase the risk of blood clots? Thank you!

Richard J. Bruneteau, MD · Answer

Deep venous thrombosis and pulmonary emboli can represent
life threatening conditions.  Several
risk factors are associated with the formation of DVT’s including birth control
pills and hormone replacement.

For these
reasons we generally recommend that patients stop taking both birth control
pills and hormone replacement two weeks prior to surgery.  In addition every patient should be evaluated
for their DVT risks.

The
majority of patients are asked to use anti embolic compression stockings,
maintain hydration and ambulate frequently. 
In patients who have multiple risk factors, anti-coagulants such as
Lovenox may be necessary.

It’s
important to realize that every patient’s situation is unique.  For this reason, treatment needs to be
individualized for every patient.

Tom J. Pousti, MD · Answer

It is probably in your best interests  to stop the hormonal replacements (under the guidance of your OB/GYN) this prior to undergoing extensive mommy makeover surgery. As you know, deep venous  thrombosis and pulmonary embolism are 2 of the more devastating complications that can occur;  it is wise to take every precaution.

	Best wishes.

Vivek Bansal, MD · Answer

Have your GYN and Board Certified Plastic Surgeon discuss your status and make any medication alterations in plenty of time.

Brent Moelleken, MD · Answer

You are best off discontinuing your hormone replacement therapy preoperatively.  Hormone replacement can increase the chance of getting a blood clot.  We ask that all our patients stop taking any form of hormone replacement, including bio-identical, over the counter, herbal, etc.

	Surgery has enough risks associated with it; why take shortcuts?

Jeffrey Zwiren, MD · Answer

It is safest to be off hormone replacement therapy prior to an abdominoplasty as this will increase your risk of a deep vein thrombosis  Estrogens are  the source of the problem as they create a hypercoagulable state.

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