Female sex hormones influence the coagulation cascade to promote blood clotting
The effect of female sex hormones on blood coagulation is complex and heavily dependent on the specific hormone formulation, route of administration, and patient context, leading to mixed findings regarding whether they promote clotting or favor fibrinolysis.
The retrieved literature contains conflicting evidence regarding the impact of female sex hormones on the coagulation cascade. While some studies and reviews highlight procoagulant changes associated with estrogen-containing oral contraceptives and hormone replacement therapies (supporting the claim), others demonstrate that certain hormone regimens (such as tibolone or specific continuous combined therapies) can enhance fibrinolysis or reduce coagulation parameters, leading to a contested verdict overall.
Manuela Farris, Carlo Bastianelli, Elena Rosato, Ivo Brosens, Giuseppe Benagiano. Pharmacodynamics of combined estrogen-progestin oral contraceptives: 2. effects on hemostasis.. 2017. https://doi.org/10.1080/17512433.2017.1356718
Reviews how combined oral contraceptives containing estrogens and progestins alter hemostasis and influence thrombotic risk.
U H Winkler, R Altkemper, B Kwee, F A Helmond, H J Coelingh Bennink. Effects of tibolone and continuous combined hormone replacement therapy on parameters in the clotting cascade: a multicenter, double-blind, randomized study.. 2000. https://doi.org/10.1016/s0015-0282(00)00587-2
Demonstrates that certain hormone therapies (tibolone) can shift hemostasis toward a more fibrinolytic profile without major coagulation activation.
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Takao Kobayashi, Masashi Hirayama, Masayoshi Nogami, Kanna Meguro, Masato Iiduka, Jean-Michel Foidart, Jonathan Douxfils, Tasuku Harada. Impact of Estetrol Combined with Drospirenone on Blood Coagulation and Fibrinolysis in Patients with Endometriosis: A Multicenter, Randomized, Open-Label, Active-Controlled, Parallel-Group Study.. 2024. https://doi.org/10.1177/10760296241286514
Shows that estrogen-containing combined hormone preparations affect coagulation and fibrinolysis cascades.
M Notelovitz. Oral contraception and coagulation.. 1985. https://doi.org/10.1097/00003081-198528010-00009
Indicates that estrogen components in oral contraceptives elevate clotting factors and impact the coagulation mechanism.
A Cano, W M Van Baal. The mechanisms of thrombotic risk induced by hormone replacement therapy.. 2001. https://doi.org/10.1016/s0378-5122(01)00270-5
Notes that sex hormone therapies can induce a procoagulant state by altering the coagulation cascade.
A Demirol, C Baykal, S Kirazli, A Ayhan. Effects of hormone replacement on hemostasis in spontaneous menopause.. 2001. https://doi.org/10.1097/00042192-200103000-00009
Finds that specific hormone replacement therapies decreased certain coagulation factors and prolonged activated partial thromboplastin time.
Aygul Demirol, Suleyman Guven, Emine Seda Guvendag Guven, Serafettin Kirazli, Timur Gurgan, Ali Ayhan. Comparison of the effects of tibolone and estrogen therapy on hemostasis in surgical menopause: a randomized, double-blind, placebo-controlled study.. 2007. https://doi.org/10.1016/j.fertnstert.2006.08.090
Indicates that certain therapies changed the overall hemostatic balance to a more fibrinolytic state rather than promoting clotting.
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