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Sex matters when it comes to venous thromboembolism ( VTE ). We defined 5P's – period, pill, prognosis, pregnancy, and postthrombotic syndrome – that should be discussed with young women with  VTE . Menstrual blood loss (Period) can be aggravated by anticoagulant therapy. This seems particularly true for direct oral anticoagulants. Abnormal uterine bleeding can be managed by hormonal therapy, tranexamic acid, or modification of treatment. The use of combined oral contraceptives (Pill) is a risk factor for  VTE . The magnitude of the risk depends on progestagen types and estrogen doses used. In women using therapeutic anticoagulation, concomitant hormonal therapy does not increase the risk of recurrent  VTE . Levonorgestrel‐releasing intrauterine devices and low‐dose progestin‐only pills do not increase the risk of  VTE . In young women  VTE  is often provoked by transient hormonal risk factors that affects  prognosis . Sex is incorporated as predictor in recurrent  VTE  risk assessment models. However, current guidelines do not propose using these to guide treatment duration. Pregnancy increases the risk of  VTE  by 4‐fold to 5‐fold. Thrombophilia and obstetric risk factors further increase the risk of pregnancy‐related  VTE . In women with a history of  VTE , the risk of recurrence during pregnancy or post partum appears to be influenced by risk factors present during the first  VTE . In most women with a history of  VTE , antepartum and postpartum thromboprophylaxis with low‐molecular‐weight heparin is indicated. Women generally are affected by  VTE  at a younger age then men, and they have to deal with long‐term complications (Post‐thrombotic syndrome) of deep vein thrombosis early in life.

Sex matters: Practice 5P's when treating young women with venous thromboembolism