Hypercoagulation in surgical postmenopausal women having hormone replacement with overdose estradiol

A benefit of estradiol replacement preventing coronary heart disease (CHD) after menopause has been suggested by clinical investigations. In the department of gynecology at our hospital, we met by chance eight senior women who were hysterectomized due to different benign gynecological disorders. Acting on their own, they took a daily dose of estradiol valerate as high as 8-50 mg for 3 years, in comparison with 1-2 mg used in routine hormonal replacement therapy. We were interested to assess whether the overdose estrogen disturbs the hemostatic function, thus losing the favorable effect on CHD occurrence. Plasma levels of some procoagulants/anticoagulants were assayed in the eight women with replacement therapy and the results were compared with those of seven age-matched senior women and of 14 young healthy women with normal menstrual cycles. Using a new laboratory method recently developed by us, the overall hemostatic potential, shown as a single parameter (Abs-sum), was also determined. Results showed that high-dose estradiol activated coagulation and depressed fibrinolysis, leading to the net effect of elevated overall hemostatic potential. Thus, the overdose estradiol replacement may not be beneficial in preventing CHD after menopause, or it may even increase the risk due to the hypercoagulable state induced therefrom.