Take 2: Progestogens

Does the type of progestogen or mode of delivery affect clotting?

Does the type of progestogen or mode of delivery affect clotting?

Professor Bronwyn Stuckey, a clinical endocrinologist and the medical director at the Keogh Institute for Medical Research in WA, discusses this in the following video.

“It depends on the progestogen actually,” she says. “So MPA, medroxyprogesterone acetate, is thought to have a more thrombotic effect. And the combination of premarin, conjugated equine oestrogens, and NPA had a greater thrombotic effect than conjugated equine oestrogens alone.

“Whether that’s the same with all the progestogens, because all the progestogens are different, and it might be that micronised progesterone does not have a thrombotic effect.

Professor Stuckey also answers the question: ‘Does the type of progestogen or mode of delivery affect lipids?’

“The problem is that the only progestogen that is reliably absorbed by the skin is norethisterone,” she says. “The only formulation that has that is the combined patch.”

Professor Stuckey’s personal view is that the safest option is generally either oral oestrogen and progestin for women or transdermal oestrogen and progestin.

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