Pulmonary embolism in women of reproductive and menopausal periods

INTRODUCTION: High morbidity and mortality from pulmonary embolism (PE) make it relevant to search for predisposing factors specific of different categories of patients.

AIM: To establish the frequency of verification of PE diagnosis, peculiarities of its course and predictors of development in women of reproductive and menopausal age.

METHODS: The study involved 238 women suspected of PE. The diagnosis was confirmed in 125 of them: 39 patients aged 23 to 43 years (Group 1), 86 patients aged 60 to 94 years (Group 2). In the remaining 113 women, PE was excluded: 41 women aged 29 to 43 (Group 3) and 72 women aged 60 to 92 years (Group 4). The identification rate and disease course were compared across the groups, and significant surgical, gynecological and therapeutic risk factors for PE were established for each life period with determination of their relationships with each other and with clinical, laboratory and instrumental factors.

RESULTS: Significant factors for PE development in women include: estrogen background (a tendency for this hormone to increase endogenously due to physiological and pathological gynecological conditions, or exogenously due to intake of hormonal drugs); the presence of thrombophilic conditions; obesity (body mass index ≥30 kg/m²); limited physical activity. The combination of these risk factors increases the likelihood of developing the disease, especially in the 23–43 age groups, which accounts for almost 30% of PE cases in women, often with thrombosis originating from the superior vena cava system.

CONCLUSION: Women at different ages have different risk factors for developing PE, primarily related to estrogen status. Absolute and relative hyperestrogenism can create predisposition to hypercoagulability and thromboembolic complications.