How long should estrogen products be stopped before bariatric surgery?

Estrogen products, particularly hormone replacement therapy (HRT), influence the risk of postoperative complications during bariatric surgery, including venous thromboembolism (VTE). The recommendation to stop the use of HRT is based on the need to minimize this risk. Stopping hormone therapy for three weeks prior to surgery allows sufficient time for the body to clear the estrogens from the system, thereby reducing the likelihood of clot formation during the perioperative period.

This strategy is supported by clinical guidelines and best practices that emphasize a balance between managing hormonal health and minimizing surgical risks. The three-week cessation aligns with the pharmacokinetics of estrogen, ensuring that levels sufficiently decrease before the surgical procedure.

Other timeframes, such as one cycle of oral contraceptive pills (OCPs) or one month of OCPs, may not provide an adequate safety margin for the clearance of hormones, and two cycles of HRT may extend the discontinuation period unnecessarily without additional benefit. Therefore, the guideline of stopping HRT for three weeks provides a pragmatic and evidence-based approach to enhance patient safety prior to undergoing bariatric surgery.