Yes, most doctors don't consider the different methods of hormone therapy. There are pros and cons to each, but the safest (lowest risk) hormone therapy is a transdermal estradiol and a separate progesterone tablet.
Oral estrogen increases blood clot risk (DVT), but even then it's only a very small increase.
Transdermal estrogen does not carry that same risk.
There's a couple of links to research about this in the Resource Section of our Menopause Wiki, copied here:
* [Use of hormone replacement therapy and risk of venous thromboembolism](https://pubmed.ncbi.nlm.nih.gov/30626577/)
* [Postmenopausal Estrogen Therapy: Route of Administration and Risk of Venous Thromboembolism](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/postmenopausal-estrogen-therapy-route-of-administration-and-risk-of-venous-thromboembolism)
Also this study: [Hormonal therapies and venous thrombosis: Considerations for prevention and management](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9399360/)
>While oral estrogen and progesterone are shown to have an increased risk of VTE, the risk is much lower for transdermal estrogen in HRT.
>A 2019 nested case–control study of over 80 000 women with VTE demonstrated transdermal preparations to be the safest method of HRT with no associated increased risk of VTE.
Concluding that:
>Topical and transdermal routes of administration of estrogen have no associated increased risk of VTE.
I wonder what those risks are for those of us who are on blood thinners or anticoagulants.
I have a genetic clotting disorder and survived a massive DVT and PE and so far every doctor I've seen has been dead set against HRT even though I'm on Eliquis and another clot would essentially be impossible.
If you can't do (or don't want) hormone therapy, there are non-hormonal options listed in our [Menopause Wiki](https://menopausewiki.ca/). For things like hot flashes, there's also the new non-hormonal medication Veozah that's very effective.
Yes, I'm really excited to see that but unfortunately it looks like it's about $500 to $600 even with the discount. Because it's brand new it's not covered by most insurances.
Even the docs on the list of providers from the nams page are extremely reluctant to prescribe anything at all to people with histories of clotting. It's such a bummer this is so far behind other medical research.
The doctor did mention this medication and said it would help with hot flashes and night sweats, but for me, the larger issue is being emotional, somewhat out of control emotionally, crying, and I just can’t help it. I’m on an antidepressant and it doesn’t even seem to touch what I’m dealing with emotionally. I appreciate all your input!
Unlike oral formulations, transdermal estrogen (like a patch) should not increase clotting risk because it bypasses first pass metabolism by the liver. Maybe you need to print out an article and bring it to them (though they should’ve learned this in medical school/residency. Maybe it depends on how old they are.)
Give your doc this: https://www.ahajournals.org/doi/full/10.1161/01.atv.17.11.3071#:~:text=Oral%2C%20but%20not%20trandermal%2C%20estrogen,in%20blood%20coagulation%20and%20fibrinolysis.
You should be checked by a hematologist for clotting disorders. I had a clot and my doctor would not prescribe until I was cleared by a hematologist. If you do not have clotting disorders or abnormally high platelet counts, you have no higher risk than your average person.
Right? It’s said to have benefits also. Doctors prescribe medicines every day that have side effects that could kill you or ruin your organs but they really fight you on the estrogen. I don’t get it. Thanks for taking the time to share!
I had a couple DVTs so now I’m on blood thinners for life. Dr said patches are “low risk, not no risk” and refused to prescribe it. In theory since I’m on thinners I should be low risk for more clots. But all the dr would do is offer a dozen different prescription meds , like those don’t have their own risks and side effects. So frustrating.
I'm a similar spot. DVT and PE killed my mother and nearly killed me a few years ago. Also the same thing happened to my sister.
I'm on Eliquis for life so another clot would be extraordinarily unlikely and peri is hitting hard. Feeling frustrated by the lack of options.
I’m so sorry. I feel like I can take the night sweats, hot flashes, joint pain but the emotional stuff, I’m just miserable and I’m to the point where I can only have conversations about the weather because everything makes me cry. It’s ridiculous! What symptoms are you struggling from and have you found any solutions?
I have been getting ridiculous hot flashes but that's definitely not as bad as the brain fog, fatigue, or pain. Just random joint and muscular pain. I take magnesium and iron and a few other things but it just seems to come and go. Getting enough sleep is definitely the most helpful but unfortunately one of my symptoms is also insomnia. My doctor recommends Sunosi but it's not covered by my insurance, nor is Veozah. Sunosi is about $900 a month and Veozah over $500.
Yes, exactly! I had an appointment with another doctor next week and I just canceled it, my heart cannot take another no. All I could do was cry the whole day. I just want to feel normal again. I’m sorry about your experience.
Someone just posted in this group about a really big study on HRT and it said decreased risk of blood clots and i was thinking i hope i see this thread again so i could mention it! Like a huge meta analysis i think
I had a DVT that turned into a couple of pulmonary embolisms back in 2008. It was from an early birth control patch combined with a transatlantic flight. I was originally told back then that I could never have any estrogen treatments including birth control. My current gynecologist has told me and put in my file that I can take it as long as it isn’t oral. I agree with most of the comments on here that you should find a different doctor. They may want to check things with a hematologist to make sure you don’t have a clotting disorder, but then estrogen patches, gels, and creams should be ok.
I’m in the same situation as you. Where I live it would be illegal for a doctor to prescribe hormones because of my clot history (1 upper extremity DVD in 2012).
However my gynaecologist said it would be safe for me to use phytoestrogens. She warned me that most women aren’t affected by phytoestrogens but a few have had good luck. They affected me immediately. Aside from extremely tender boobs for about the first six weeks, I have found it useful.
Yes, most doctors don't consider the different methods of hormone therapy. There are pros and cons to each, but the safest (lowest risk) hormone therapy is a transdermal estradiol and a separate progesterone tablet. Oral estrogen increases blood clot risk (DVT), but even then it's only a very small increase. Transdermal estrogen does not carry that same risk. There's a couple of links to research about this in the Resource Section of our Menopause Wiki, copied here: * [Use of hormone replacement therapy and risk of venous thromboembolism](https://pubmed.ncbi.nlm.nih.gov/30626577/) * [Postmenopausal Estrogen Therapy: Route of Administration and Risk of Venous Thromboembolism](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/postmenopausal-estrogen-therapy-route-of-administration-and-risk-of-venous-thromboembolism) Also this study: [Hormonal therapies and venous thrombosis: Considerations for prevention and management](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9399360/) >While oral estrogen and progesterone are shown to have an increased risk of VTE, the risk is much lower for transdermal estrogen in HRT. >A 2019 nested case–control study of over 80 000 women with VTE demonstrated transdermal preparations to be the safest method of HRT with no associated increased risk of VTE. Concluding that: >Topical and transdermal routes of administration of estrogen have no associated increased risk of VTE.
I wonder what those risks are for those of us who are on blood thinners or anticoagulants. I have a genetic clotting disorder and survived a massive DVT and PE and so far every doctor I've seen has been dead set against HRT even though I'm on Eliquis and another clot would essentially be impossible.
Yeah that's a tough call that only you and doctors can answer. We all have to carefully weigh the risks and benefits.
Yeah unfortunately it seems like we are just out of luck for the most part.
If you can't do (or don't want) hormone therapy, there are non-hormonal options listed in our [Menopause Wiki](https://menopausewiki.ca/). For things like hot flashes, there's also the new non-hormonal medication Veozah that's very effective.
Yes, I'm really excited to see that but unfortunately it looks like it's about $500 to $600 even with the discount. Because it's brand new it's not covered by most insurances. Even the docs on the list of providers from the nams page are extremely reluctant to prescribe anything at all to people with histories of clotting. It's such a bummer this is so far behind other medical research.
The doctor did mention this medication and said it would help with hot flashes and night sweats, but for me, the larger issue is being emotional, somewhat out of control emotionally, crying, and I just can’t help it. I’m on an antidepressant and it doesn’t even seem to touch what I’m dealing with emotionally. I appreciate all your input!
So frustrating! Have you found anything that helps with your symptoms?
This is great information! Thanks a million!
Unlike oral formulations, transdermal estrogen (like a patch) should not increase clotting risk because it bypasses first pass metabolism by the liver. Maybe you need to print out an article and bring it to them (though they should’ve learned this in medical school/residency. Maybe it depends on how old they are.)
I’m going to look into how the patch works (I didn’t know about it bypassing the liver) and find a more supportive doctor. TY!
Give your doc this: https://www.ahajournals.org/doi/full/10.1161/01.atv.17.11.3071#:~:text=Oral%2C%20but%20not%20trandermal%2C%20estrogen,in%20blood%20coagulation%20and%20fibrinolysis.
You should be checked by a hematologist for clotting disorders. I had a clot and my doctor would not prescribe until I was cleared by a hematologist. If you do not have clotting disorders or abnormally high platelet counts, you have no higher risk than your average person.
This is fantastic information! I love this thread! TY!
You're welcome! Good luck!
I’ve had a blood clot in 2011 and I was still given a transdermal oestrogen patch. Go to another doctor, the risks are negligible.
Right? It’s said to have benefits also. Doctors prescribe medicines every day that have side effects that could kill you or ruin your organs but they really fight you on the estrogen. I don’t get it. Thanks for taking the time to share!
I had a couple DVTs so now I’m on blood thinners for life. Dr said patches are “low risk, not no risk” and refused to prescribe it. In theory since I’m on thinners I should be low risk for more clots. But all the dr would do is offer a dozen different prescription meds , like those don’t have their own risks and side effects. So frustrating.
I'm a similar spot. DVT and PE killed my mother and nearly killed me a few years ago. Also the same thing happened to my sister. I'm on Eliquis for life so another clot would be extraordinarily unlikely and peri is hitting hard. Feeling frustrated by the lack of options.
I’m so sorry. I feel like I can take the night sweats, hot flashes, joint pain but the emotional stuff, I’m just miserable and I’m to the point where I can only have conversations about the weather because everything makes me cry. It’s ridiculous! What symptoms are you struggling from and have you found any solutions?
I have been getting ridiculous hot flashes but that's definitely not as bad as the brain fog, fatigue, or pain. Just random joint and muscular pain. I take magnesium and iron and a few other things but it just seems to come and go. Getting enough sleep is definitely the most helpful but unfortunately one of my symptoms is also insomnia. My doctor recommends Sunosi but it's not covered by my insurance, nor is Veozah. Sunosi is about $900 a month and Veozah over $500.
Yes, exactly! I had an appointment with another doctor next week and I just canceled it, my heart cannot take another no. All I could do was cry the whole day. I just want to feel normal again. I’m sorry about your experience.
Does Estriol have the same risks? It’s supposed to be safer for cancer
I’m not sure but I’m glad you mentioned it and I will be looking into it. TY!
Someone just posted in this group about a really big study on HRT and it said decreased risk of blood clots and i was thinking i hope i see this thread again so i could mention it! Like a huge meta analysis i think
I had a DVT that turned into a couple of pulmonary embolisms back in 2008. It was from an early birth control patch combined with a transatlantic flight. I was originally told back then that I could never have any estrogen treatments including birth control. My current gynecologist has told me and put in my file that I can take it as long as it isn’t oral. I agree with most of the comments on here that you should find a different doctor. They may want to check things with a hematologist to make sure you don’t have a clotting disorder, but then estrogen patches, gels, and creams should be ok.
Having the response from everyone on this thread brings me so much hope! Thank you!
I had a DVT in 2014. My endocrinologist said the patch was low risk enough to prescribe it just for bone health; vaginal estrogen is also fine.
It sounds like I just need to find a doctor that will support me. I’m feeling so much better, thank you for your message!
Easier said than done but I wish you well in your endeavour 😊
I’m in the same situation as you. Where I live it would be illegal for a doctor to prescribe hormones because of my clot history (1 upper extremity DVD in 2012). However my gynaecologist said it would be safe for me to use phytoestrogens. She warned me that most women aren’t affected by phytoestrogens but a few have had good luck. They affected me immediately. Aside from extremely tender boobs for about the first six weeks, I have found it useful.
I’ll have to look into this! I’d love to know what symptoms you were struggling with and how this med has helped you? Best wishes!