Would you consider utilizing transdermal estrogen for HRT to treat severe hot flashes in a patient with SLE and a history of thrombosis x2 and positive lupus anticoagulant, but negative aCL/B2GP1 abs?

Given the prothrombotic effects of estrogen, they are generally avoided in patients with prior thrombosis and hypercoagulable states. Therefore, in a patient with SLE, secondary anti-phospholipid syndrome, as a single positive aPL with a positive lupus anticoagulant, and prior thrombotic event, the ...

Per the most recent reproductive guidelines (Sammaritano et al., PMID 32090466), I'd only recommend IUD (tx of choice) or progestin-only pill. I would lean toward the IUD since its rate of contraception is greater than the progestin-only pill.