I often see patients coming to me from other offices that are on oral estrogens for menopause symptoms, specifically hot flashes. They come to our office because they have heard about bioidentical hormone replacement and want to understand about their options. As I enjoy educating my patients on hormones, both patients were surprised to hear that oral estrogen has been shown to increase the risk of venous thromboembolisms (VTE) or blood clots in the leg or lungs. However, transdermal estrogen does not increase the risk of VTE. Thus there really is no reason to prescribe oral estrogen for menopausal symptoms.
There have been numerous studies that have looked at the safety of transdermal estrogen but the largest study looked at data from the British Million Women’s Study, where investigators compared the risk of VTE between oral and transdermal estrogen. The risk of VTE was significantly elevated with the use of oral estrogen, and there was no elevation among users of transdermal therapy. The American College of ObGyn (ACOG) in April 2013 published, “When prescribing estrogen therapy, the gynecologist should take into consideration the possible thrombosis-sparing properties of transdermal forms of estrogen therapy.”
I specifically recommend using estradiol transdermal, either placed as a cream on the skin or a pellet under the skin. Estradiol is the same hormone that your ovary produced prior to menopause. It’s considered a bioidentical hormone. Whereas the hormones in birth control pills and Premarin are synthetic hormones and have a different molecular structure compared to the estrogen a women naturally makes. I believe that it’s better to do hormone replacement in women with what their body makes and not use a synthetic hormone that is chemically structured different.
Also it is important to mention that natural progesterone taken orally does not increase the risk of blood clots. There are many benefits of taking progesterone and sometimes I do prescribe it orally. Especially if a patient has difficulty with sleeping. Oral progesterone works great for women that have difficulty falling asleep and those who wake up throughout the night.
So if you are taking oral estrogens for menopause symptoms you need to STOP!!! Ask your doctor for transdermal estrogen. We usually recommend it in a cream or pellet format. If they are not aware of this, it’s time to look elsewhere.