Pregnancy, Menopause, and Decision-Making in Women's Health

Women’s health needs frequently evolve throughout their lifespan. Pregnancy and menopause are two distinct life stages that prompt new questions and significant healthcare decisions. Although these experiences differ, both involve hormonal changes, shifting health considerations, and the need for informed discussions with trusted healthcare providers.

At the Rowan Foundation, we believe that women deserve clear and balanced information at every stage of life. Understanding the evolving nature of health needs during pregnancy and menopause can foster greater preparedness, confidence, and support.

Pregnancy: Planning, Awareness, and Maternal Health Considerations

Pregnancy is usually a time of excitement and planning, but it also brings significant physical and hormonal changes. These changes are normal and help support pregnancy and prepare the body for childbirth. However, they may also temporarily increase the body’s tendency to form blood clots.

During pregnancy, elevated hormone levels, particularly estrogen, increase clotting factors and reduce natural anticoagulant activity. Uterine enlargement may compress pelvic veins, reducing blood flow in the lower extremities. Additional factors, including reduced mobility, dehydration, cesarean delivery, and postpartum recovery, further increase risk. Collectively, these changes account for the heightened risk of clotting during pregnancy and the postpartum period.

Pregnancy-associated venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects an estimated 1 to 2 pregnancies per 1,000 deliveries,¹ with the highest risk occurring after childbirth.² The postpartum period may carry a risk several times higher than during pregnancy.

For most women, pregnancy proceeds without serious complications. Still, awareness is critical for those with additional risk factors, including:

Personal or family history of blood clots
Inherited clotting disorders
Prolonged bed rest or limited mobility
Cesarean delivery
Obesity or smoking
Certain medical conditions
Age-related risk factors

Women who are pregnant or planning a pregnancy may benefit from discussing their health history early with an obstetric provider or specialist, when appropriate. Helpful conversations may include:

Prior pregnancy complications
Personal or family history of clotting
Safe medication use during pregnancy
Warning signs that should prompt urgent care
Postpartum recovery and follow-up care
Whether preventive measures are recommended

Pregnancy also underscores the importance of maternal health, encompassing emotional well-being, access to support, and assurance of being heard throughout the care process.

Menopause: A New Phase in Health Decision-Making

Menopause is a significant life transition, often accompanied by physical, emotional, and lifestyle changes. Common symptoms include hot flashes, sleep disturbances, mood swings, vaginal dryness, and long-term changes in bone and cardiovascular health.

Some women consider hormone therapy to manage symptoms, while others prefer nonhormonal methods or lifestyle changes. There is no one-size-fits-all approach.

Current clinical guidelines identify hormone therapy as the most effective treatment for bothersome hot flashes and night sweats. It may also help relieve menopausal vaginal and urinary symptoms. For many healthy women under 60 years of age or within 10 years of menopause onset, the benefits may outweigh the risks when therapy is individualized and regularly reassessed.³

Experts recommend using the lowest effective dose, choosing the most appropriate route of administration, and tailoring treatment duration to individual symptoms, goals, and risk factors. Some evidence suggests that transdermal formulations, such as patches, may carry a lower risk of blood clots than oral estrogen for certain individuals.⁴

Healthcare decisions during menopause may involve discussions about:

Severity of symptoms and quality of life
Personal and family medical history
Cardiovascular health
Bone health and osteoporosis prevention
Risk of blood clots and whether hormone therapy is appropriate
Nonhormonal treatment options
Route of administration and dosage options

For some women, certain forms of hormone therapy may be contraindicated due to individual risk factors. A personal or family history of blood clots, stroke, hormone-sensitive malignancies, liver disease, or other conditions may influence the safest therapeutic approach.⁵

The Importance of Informed Healthcare Conversations

Pregnancy and menopause underscore that healthcare decisions often change with age, life stage, and shifting priorities. Choices that were appropriate in the past may no longer be optimal. Regular consultations with healthcare providers and periodic reassessment of health needs are therefore essential.

Women should feel empowered to ask questions such as:

What health risks should I be aware of at this stage of life?
Are there lifestyle changes that may help?
What treatment options are available to me?
Are there any clotting concerns I should discuss?
Which symptoms should not be ignored?

Support Throughout Every Life Stage

At the Rowan Foundation, we are committed to helping women make informed health decisions throughout their lives. To support these discussions, we invite readers to explore our educational resources on pregnancy, menopause, blood-clot awareness, and women’s health.

With access to reliable information and proactive healthcare, women can approach each life stage with greater confidence and assurance.