Are estrogens contraindicated in some women?
YES!! Because they can sharply raise triglycerides in women with increased triglycerides, causing pancreatitis, stroke, and heart attack, they are contraindicated in the following women: • All women with fasting plasma triglycerides >500 mg/dl. • Most women with fasting plasma triglycerides >300 mg/dl. Before starting post menopausal estrogens, or if already on postmenopausal estrogens without a previous fasting triglyceride level determination, measure fasting triglycerides. • Women heterozygous for either the mutant Factor V Leiden gene or prothrombin gene mutation (Molecular Diagnostics Laboratories (MDL)) (about 6% of unselected American women). The mutant Factor V Leiden gene causes resistance to activated protein C, which increases the risk of blood clots. Since at least 6% of unselected American women (and men) have the V Leiden mutation, we and others now suggest that a measurement of resistance to activated protein C be made before either post-menopausal estrogens or oral cont
