Pregnancy increases the risk of venous thromboembolism (VTE) by about four to five times compared with being non-pregnant.9,10,11 The risk is highest during the first six weeks after delivery, when the risk of VTE may be about 20 times higher than in non-pregnant women.12,13,14

Pregnancy increases clotting risk because of changes that help prevent excessive bleeding during childbirth, including changes that make blood clot more easily, slower blood flow and pressure on veins from the growing uterus.

Blood clots can occur at any point during pregnancy or after delivery. Deep vein thrombosis (DVT) during pregnancy is more likely to occur in the left leg.

Women with a previous blood clot, thrombophilia or other risk factors may need medication to prevent blood clots during pregnancy and after delivery. Low molecular weight heparin (LMWH) is commonly used when anticoagulation is needed during pregnancy.

VTE risk should be assessed during pregnancy and after delivery, particularly at the first prenatal visit, during hospitalization and following childbirth.

Perimenopause typically begins in a woman’s mid-to-late 40s and can cause symptoms such as hot flashes, night sweats and sleep disturbances.18 For women considering hormone therapy to manage these symptoms, the type of hormone therapy matters. Oral estrogen therapy is associated with an approximately two- to three-fold increase in VTE risk, while transdermal estrogen delivered through patches, gels or sprays appears to have a much lower VTE risk.19–24

Special Considerations for Women at Risk

Women with inherited blood-clotting conditions, such as Factor V Leiden or the prothrombin gene mutation, may have a higher risk of VTE when using hormone therapy. Women with a previous blood clot may still be candidates for menopausal hormone therapy, and transdermal estrogen may be considered in some cases. Treatment decisions should be individualized and made with a healthcare professional.25

Long-Term Cardiovascular Health

**Early menopause, particularly before age 45, is associated with an increased risk of cardiovascular disease and stroke later in life.**26–28 The decline in estrogen during menopause is associated with changes in cardiovascular risk factors, making heart and blood vessel health an important part of women’s health during and after the menopausal transition.

This version preserves the key information you had: when perimenopause occurs, symptoms, oral vs. transdermal therapy, the VTE statistics, thrombophilia, Factor V Leiden, prothrombin mutation, previous VTE, individualized treatment and early menopause/cardiovascular risk, without making the section feel overwhelming.