Blood Clot Risk Is Lower For Estrogen-Only, Transdermal, And Vaginal Estrogen Hormone Therapy

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So many women have been afraid to use hormone therapy (HT) to ease their menopausal symptoms such as hot flashes and night sweats because the initial reporting of the WHI 2002 study linked the non-bioidentical versions of the female hormones estrogen and progesterone to an increased risk of breast cancer, heart attacks, and strokes.

Menopause, the Journal of North American Menopause Society (NAMS) published new research, from the Karolinska Institute in Stockholm led by Dr. Annica Bergendal, which found that overall, estrogen-only therapy carries a lower risk of blood clots than treatment with a combination of estrogen and progestin, the synthetic version of progesterone.

According to Science Daily, the study highlights that the way estrogen is delivered may impact the risks.  There was no increased risk of VTE (venous thromboembolism) in this study for women who used transdermal estrogen (such as patches), either alone or in combination with a progestogen. And women who used vaginal estrogen alone to ease vaginal dryness and other symptoms of genitourinary syndrome of menopause (GSM) also had no increased risk of VTE. Many menopause experts don’t expect vaginal estrogen to raise the risk because absorption into the bloodstream is small and results in levels similar to those in postmenopausal women who use no hormones. But studies on this question have been rare, noted the authors, so this finding is a big help for decision making.

“This study adds to our knowledge that transdermal estrogen therapies are safer than oral, and that different estrogen or progestogen combinations may have different risks,” says NAMS Executive Director JoAnn V. Pinkerton, MD, NCMP. “The lack of blood clots with transdermal estrogen and with vaginal estrogen is very reassuring for women who need to continue taking hormones as they age when risk of blood clots increases.”

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • That’s very interesting. I think I’ve read something like this before but while ago.

    • I like to be sure women are up on the latest info!

  • Cathy Lawdanski

    Information that I did not know. Thanks for sharing. It’s very important that we are informed when discussing our options with our physicians.

    • It does help you be a good health advocate for yourself. I come into my appointments with my questions written down. The time is short with my menopause specialist! I want to make the most of each second!

  • sue

    Thank you Ellen. There is so much information out there that you sometimes switch off because it becomes overwhelming. Thanks for writing so clearly and providing valuable information.

    • I am happy it is helpful, Sue. I try to take the info and put it into layperson speak!

  • doreenmcgettigan

    This is great information, Ellen. It can all be so confusing especially when my doctors disagree with one another and put me in the position to make the best choice for myself.

    • Yep…..I am hoping my website helps women become their own BEST health advocate! If you ever have any questions, feel free to email me at ellendolgen@ellendolgen.com. I will do my best to help you find the answers.

  • Great info. And timely for me, as I prepare for my annual checkup.

  • Lisa_GrandmasBriefs

    Thank you, Ellen. Sounds like estrogen-only therapy is the way to go. I’ve had blood clot scares in the past, so this is important info for me. Thank you.

    • If you have a uterus you need to have progesterone, too. The key is that they found that transdermal bioidentical estrogen doesn’t have an increase is blood clots or thrombosis. This is new information. Also, women with dry vagina who need to use vaginal estrogen cream do not need to worry about the risk of thrombosis, either. All good news for the vagina!

  • In this one area I am so lucky that menopause has been easy, even if it did give me a chicken neck. Peri-menopause was the worst and most volatile time of my life.

    • Haha…I hear ya. I try not to look at my neck or my wrinkling knees! No one ever prepared me for that one!

  • Lois Alter Mark

    I keep sharing your posts with friends. Thank you for the always-valuable information.

    • Thanks for sharing the info, Lois. It’s hard to keep up on the latest studies…it’s my hope this info helps women make their healtcare decisions on fact instead of fear.

  • Mirla Castillo

    I am still too skeptical about those studies, synthetic estrogen is a double side sword. My OB doctor told me that some women with dense breasts are not the best to take estrogen. I noticed that many older women in my town, including relatives never took hormones therapy and they still alive and healthy. I am planning the same way. Eat healthy, exercise and take vitamins, minerals plus my home made soymilk,plus iodine!. So far so good!

    • Sounds like your symptoms are not affecting your quality of life in any way. Be sure to do check your bone density, cholesterol, and when you have your pap get the PH checked in your vagina!

      • Mirla Castillo

        Thanks for your advice! I am checking cholesterol already and my OB told me the vagina still looks moist at 51! Must be the phytoestrogen from my pure soymilk. Low fat carbs is a must at this stage.

  • Heidi Wells

    Hi I am new to this group and have a question please. After 6 months in various estrogen/progesterone patches gels – all made my breasts hurt so much I came off them. Now I’m sweating flushing non stop, feel so low one minute etc – saw a UK HrT specialist last week and have been put on low dose 25mg patch of east roger – but I have a womb! I am so scared been told to have scans every 6 months but it sounds very dangerous – they thought my breast pain and spotting was the progesterone but only started this a few days ago and can feel my breasts hurting – I am running out of options here as they seem to think there is nothing else I can do – what’s your thoughts please as this doesn’t sound like a good idea because of the thickening if the vaginal lining ahh! Going crazy- on the nhs here they don’t believe in hormone creams and they can’t prescribe them – thank you Heidi

  • Heidi Wells

    Hi just to say I am 53 and always had sore breasts before my periods – which stopped 2 years ago – I tried all the natural alternatives before try HRT – it is meant to say estrogen below! Thx can this make my breasts sore? Thx heidi wells

  • Sarah

    Hi Ellen , I just started HRT 2 weeks ago . I am still miserable and dissapointed that I haven’t felt any relief , I have heard so many people feel some relief after one or two days . Will it get better or should dosage be increased ? Thank you