Exploring the risk of venous thromboembolism in women with rheumatoid arthritis initiating menopausal hormone treatment in England

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ID: 321709
2026
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Abstract
Abstract Objectives While rheumatoid arthritis (RA) and menopausal hormone treatment (MHT) are known to increase the risk of venous thromboembolism (VTE), how MHT influences VTE incidence within the RA population has not been well-characterised. This study aimed to evaluate whether MHT is associated with an increased risk of VTE in peri- and post-menopausal women with RA. Methods We conducted a retrospective, matched cohort study using UK primary care data from the Clinical Practice Research Datalink (CPRD) Aurum, linked to secondary care, from 2001 to 2021. Women aged 40 to 79 years with RA initiating MHT were matched to women with RA not initiating MHT. VTE incidence rates were calculated, and Cox proportional hazards models adjusted for risk factors estimated the MHT-associated VTE risk. Results A total of 2,187 women with RA initiating MHT were matched to 8,205 unexposed controls. VTE incidence was higher among MHT users: 6.49 (95% confidence interval [CI]: 4.28-9.44) per 1,000 person-years vs. 3.30 (95% CI: 2.44–4.36). MHT use was associated with a 92% increased risk of VTE in RA (adjusted hazard ratio [aHR]: 1.92; 95% CI: 1.19–3.12), primarily driven by a higher risk of deep vein thrombosis (DVT, aHR: 2.26; 95% CI: 1.26-4.05). Conclusion MHT use in peri- and post-menopausal women with RA is associated with a two-fold increased risk of VTE, particularly DVT, relative to unexposed controls. Individualised risk assessment and monitoring are advised, taking into account the patient’s clinical context. Clinicians should balance MHT benefits against thrombotic risks and consider alternatives or preventive strategies.
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Authors Eva Henning, Gulraj S. Matharu, Maciej Czachorowski, Saqib Rana, Marzieh Araghi, Hannah Alldrit, Catarina L Santos, Maya H Buch, James Galloway, Michael McLean
Journal Rheumatology Advances in Practice
Year 2026
DOI
10.1093/rap/rkag087
URL
https://doi.org/10.1093/rap/rkag087
Keywords Keywords not found

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