Summary Objective Hormone replacement therapy (HRT) is used to manage menopausal symptoms, but its perioperative use raises concerns about increased venous thromboembolism (VTE) risk. Clinical guidelines vary, with some advising temporary discontinuation before surgery. This scoping review aims to synthesise evidence and guidance on whether perioperative cessation of HRT influences postoperative VTE risk. Design A systematic search of PubMed and the Cochrane Library identified studies evaluating pre-operative HRT and VTE outcomes. Search terms included Hormone Replacement Therapy, HRT, Venous Thromboembolism, Venous Thrombosis, Pulmonary Embolism, Perioperative Care and Surgical Procedures, Operative. Participants Studies included adult women on HRT undergoing surgery and assessed discontinuation and VTE risk. Data were synthesised narratively. Results The search identified 246 records, four of which met the inclusion criteria: three primary studies and one systematic review. Only one study compared perioperative continuation versus cessation of HRT and found no significant increase in postoperative VTE with continued use. Other studies examined HRT among multiple VTE risk factors, with inconsistent findings. Clinical guidelines recognise oral oestrogen as a VTE risk factor and distinguish between higher-risk oral and lower-risk transdermal formulations; however, few provide explicit perioperative recommendations. Conclusion Evidence is limited and insufficient to support routine perioperative HRT cessation. The only comparative study found no significant increase in VTE with continuation, though limitations restrict interpretation. Overall, the literature reflects uncertainty. Given limited and heterogeneous data, perioperative HRT management should be individualised. Further prospective research is needed to determine whether temporary withdrawal, particularly of oral oestrogen, reduces postoperative VTE risk.
helmy et al. (2026) studied this question.