How would you approach a young patient with a history of APLS and VTE, desiring hormone replacement therapy after oophorectomy?

I think the answer is not straightforward. What APLAs are positive and what was/is the titer? Were there other risk factors at the time of the clot (smoking, oral contraceptives, etc...) My general recommendation would be to avoid estrogens in patients with APLAs. I can imagine a scenario where the patient had borderline positive APLAs and other clotting risk factors at the time of the clot where one could consider low dose estrogen replacement but as we don't have this information, I would avoid estrogens in this patient.