Are you using the contraceptive pill, a hormone ring or patch, or hormone replacement during the menopause? These hormone preparations often contain oestrogen, and this is relevant to report with an eyelid correction because of a possibly increased risk of thrombosis.
Which medication does this concern?
- Combination pill (oestrogen + progestogen), for example Microgynon, Marvelon, Yasmin
- Hormone ring (NuvaRing) and hormone patch (Evra)
- Hormone therapy for the menopause (HRT), oestrogen and/or progesterone preparations, in tablet form or as a patch/gel
- Progestogen-only contraception (mini-pill, contraceptive injection, hormone coil); these contain no oestrogen and have a different risk profile
Why is this relevant?
Hormone preparations that contain oestrogen increase the risk of thrombosis (a blood clot, particularly deep vein thrombosis and pulmonary embolism) [1,2]. This risk applies both to the contraceptive pill and to hormone therapy during the menopause [3].
Surgical procedures already increase the thrombosis risk in themselves. With a combination of an elective operation and oestrogen-containing medication, some guidelines advise pausing this medication a few weeks before a major operation [1,4].
An eyelid correction under local anaesthetic is a small, short procedure under local anaesthetic; the risk here is considerably lower than with major operations under general anaesthesia. Still, the use of oestrogen-containing medication is taken into account as standard in the risk inventory with cosmetic surgery [5].
Points of attention
- Oestrogen-containing contraception and hormone therapy increase the thrombosis risk, particularly in combination with other risk factors such as smoking, being overweight or prolonged immobility [1,2,3]
- Progestogen-only products (mini-pill, contraceptive injection, hormone coil) do not have this increased risk, or have it to a much lesser extent
- With a short procedure under local anaesthetic, such as an eyelid correction, the risk is limited, but is taken into account as standard [5]
Our protocol at Kliniek het Bolwerk
1. Extensive medical history
We ask about the use of hormonal contraception or hormone therapy, and about other risk factors for thrombosis, such as smoking, being overweight, or a previous thrombosis.
2. Risk assessment
For an eyelid correction under local anaesthetic, stopping hormonal contraception or hormone therapy is usually not necessary, given the short duration of the procedure and the fact that you are quickly mobile again [5].
3. Extra attention with several risk factors
With a combination of several risk factors (for example smoking and hormone use and being overweight), we discuss together whether extra precautions are desirable [1,2].
4. Mobilising after the procedure
We advise not to remain lying still for too long after the procedure, and simply to move normally again as soon as you can.
Important: with an eyelid correction under local anaesthetic, it is in most cases not necessary to stop the contraceptive pill, hormone ring or hormone therapy. Do always report the use, though, so that we can take this into account in the overall risk assessment.
When do we advise against the procedure (for the time being)?
- In the case of a previous thrombosis or pulmonary embolism, without consultation with the treating doctor
- In the case of a combination of several serious risk factors for thrombosis
- If the prescribing doctor advises against the procedure at this time
Our advice
Are you using hormonal contraception or hormone therapy? Simply mention this during the intake consultation at Kliniek het Bolwerk, together with any other risk factors for thrombosis.
Literature references
The publications below form the medical-scientific basis of this article:
- Hormonal therapies and venous thrombosis: Considerations for prevention and management. Research and Practice in Thrombosis and Haemostasis. 2022. https://onlinelibrary.wiley.com/doi/full/10.1002/rth2.12763
- Oral contraceptives and hormone replacement therapy: How strong a risk factor for venous thromboembolism? ScienceDirect. 2021. https://www.sciencedirect.com/science/article/abs/pii/S0049384821001031
- Oral contraceptives, hormone replacement therapy and thrombosis. PubMed. https://pubmed.ncbi.nlm.nih.gov/11486996/
- Combined oral contraceptive pill and surgery. GPnotebook / Primary Care Notebook. 2018. https://primarycarenotebook.com/pages/surgery/combined-oral-contraceptive-pill-and-surgery
- Venous Thromboembolism following Elective Aesthetic Plastic Surgery: A Longitudinal Prospective Study in 1254 Patients. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206918/
